2021 Medicare Part D Plan Formulary Information |
Cigna Secure Rx (PDP) (S5617-163-0)
Benefit Details
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The Cigna Secure Rx (PDP) (S5617-163-0) Formulary Drugs Starting with the Letter D in CMS PDP Region 33 which includes: HI Plan Monthly Premium: $52.80 Deductible: $445 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 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover D-AMPHETAMINE ER 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
D-AMPHETAMINE ER 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover D-AMPHETAMINE ER 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
D5%-1/2NS-KCL 10 MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover D5%-1/2NS-KCL 10 MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
D5%-1/2NS-KCL 30 MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover D5%-1/2NS-KCL 30 MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
D5%-1/2NS-KCL 40 MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover D5%-1/2NS-KCL 40 MEQ/L IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in HI cover DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | P Q:60 /30Days |
DALIRESP 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DALIRESP 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
DALIRESP 500 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DALIRESP 500 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:30 /30Days |
DANAZOL 100 MG CAPSULE [Danocrine] ![Compare how all Medicare Part D PDP plans in HI cover DANAZOL 100 MG CAPSULE [Danocrine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DAPSONE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DAPSONE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DAPTACEL DTAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in HI cover DAPTACEL DTAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in HI cover DAPTOMYCIN 350 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
DAPTOMYCIN 500 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in HI cover DAPTOMYCIN 500 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
DAURISMO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DAURISMO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
DAURISMO 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DAURISMO 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 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 HI cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DEFERASIROX 180 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in HI cover DEFERASIROX 180 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DEFERASIROX 360 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in HI cover DEFERASIROX 360 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DEFERASIROX 90 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in HI cover DEFERASIROX 90 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
DELSTRIGO 100-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DELSTRIGO 100-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
DENAVIR 1% CREAM (g) ![Compare how all Medicare Part D PDP plans in HI cover DENAVIR 1% CREAM (g).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEPEN 250MG TITRATAB ![Compare how all Medicare Part D PDP plans in HI cover DEPEN 250MG TITRATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:30 /30Days |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in HI cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:30 /30Days |
DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in HI cover DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in HI cover DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DESMOPRESSIN ACETATE NASAL SOLUTION 0.1% 5 ML BOTSPR ![Compare how all Medicare Part D PDP plans in HI 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 |
50% | 50% | None |
DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea] ![Compare how all Medicare Part D PDP plans in HI cover DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia] ![Compare how all Medicare Part D PDP plans in HI cover DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
Desoximetasone 0.0005 MG/MG Topical Ointment ![Compare how all Medicare Part D PDP plans in HI cover Desoximetasone 0.0005 MG/MG Topical Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOXIMETASONE 0.05% CREAM (G) [Topicort LP] ![Compare how all Medicare Part D PDP plans in HI cover DESOXIMETASONE 0.05% CREAM (G) [Topicort LP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESOXIMETASONE 0.25% CREAM ![Compare how all Medicare Part D PDP plans in HI cover DESOXIMETASONE 0.25% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESOXIMETASONE 0.25% OINTMENT [Topicort] ![Compare how all Medicare Part D PDP plans in HI cover DESOXIMETASONE 0.25% OINTMENT [Topicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DESVENLAFAXINE SUC ER 100 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in HI cover DESVENLAFAXINE SUC ER 100 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
DESVENLAFAXINE SUC ER 25 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in HI cover DESVENLAFAXINE SUC ER 25 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
DESVENLAFAXINE SUCCNT ER 50 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in HI cover DESVENLAFAXINE SUCCNT ER 50 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 0.5MG/5ML ELX ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 0.5MG/5ML ELX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in HI cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
DEXILANT DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DEXILANT DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:30 /30Days |
DEXMETHYLPHENIDATE 10 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in HI cover DEXMETHYLPHENIDATE 10 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in HI cover DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DEXMETHYLPHENIDATE 5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in HI cover DEXMETHYLPHENIDATE 5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DEXTROAMP-AMPHET ER 10 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 10 MG CAPSULE ER 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHET ER 15 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 15 MG CAPSULE ER 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 20 MG CAPSULE ER 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAPSULE ER 24H [Mydayis] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 25 MG CAPSULE ER 24H [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 30 MG CAPSULE ER 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHET ER 5 MG CAPSULE ER 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHETAMIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMP-AMPHETAMIN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROAMPHETAMINE ER 10 MG CAPSULE ER [Dexedrine Spansule] ![Compare how all Medicare Part D PDP plans in HI cover DEXTROAMPHETAMINE ER 10 MG CAPSULE ER [Dexedrine Spansule].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI 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 |
$30.00 | $90.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 10%-WATER IV SOLUTION DEHP FR BG ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 10%-WATER IV SOLUTION DEHP FR BG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 5%-0.2% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 5%-0.2% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 5%-0.45% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 5%-0.45% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 5%-0.9% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 5%-0.9% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE 5%-WATER IV SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE 5%-WATER IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in HI cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIACOMIT 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DIACOMIT 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:360 /30Days |
DIACOMIT 250 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in HI cover DIACOMIT 250 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:360 /30Days |
DIACOMIT 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DIACOMIT 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIACOMIT 500 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in HI cover DIACOMIT 500 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:180 /30Days |
DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:120 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:1200 /30Days |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in HI cover DIAZEPAM 5 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:240 /30Days |
DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem] ![Compare how all Medicare Part D PDP plans in HI cover DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DICLOFENAC 0.1% EYE DROPS [Voltaren] ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC 0.1% EYE DROPS [Voltaren].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC POT 50 MG TABLET [Cataflam] ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC POT 50 MG TABLET [Cataflam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOFENAC SOD EC 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC SOD EC 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOFENAC SOD EC 50 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC SOD EC 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC SOD EC 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOFENAC SODIUM 1% GEL [Voltaren Gel] ![Compare how all Medicare Part D PDP plans in HI cover DICLOFENAC SODIUM 1% GEL [Voltaren Gel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:1000 /28Days |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DICLOXACILLIN SODIUM 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE [Bentyl] ![Compare how all Medicare Part D PDP plans in HI cover DICYCLOMINE 10 MG CAPSULE [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET [Bentyl] ![Compare how all Medicare Part D PDP plans in HI cover DICYCLOMINE 20 MG TABLET [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in HI cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in HI 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 |
25% | N/A | Q:20 /10Days |
DIFICID 40 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover DIFICID 40 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:136 /10Days |
DIFLUNISAL 500 MG TABLET [Dolobid] ![Compare how all Medicare Part D PDP plans in HI cover DIFLUNISAL 500 MG TABLET [Dolobid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIGITEK 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIGITEK 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGITEK 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIGITEK 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGOX 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIGOX 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGOX 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIGOX 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin] ![Compare how all Medicare Part D PDP plans in HI cover DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in HI cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in HI cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in HI cover DIHYDROERGOTAMINE 4 MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in HI cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24H ER(LA) 180 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24H ER(LA) 180 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24H ER(LA) 240 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24H ER(LA) 240 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24H ER(LA) 300 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24H ER(LA) 300 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24H ER(LA) 360 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24H ER(LA) 360 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in HI cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in HI cover DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /180Days |
DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in HI cover DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:14 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in HI cover DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix] ![Compare how all Medicare Part D PDP plans in HI 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 |
$30.00 | $90.00 | 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 HI 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 |
$30.00 | $90.00 | None |
DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro] ![Compare how all Medicare Part D PDP plans in HI cover DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in HI cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | 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 HI 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) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIPYRIDAMOLE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIPYRIDAMOLE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIPYRIDAMOLE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIPYRIDAMOLE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DIPYRIDAMOLE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIPYRIDAMOLE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DISULFIRAM 500 MG TABLET [Antabuse] ![Compare how all Medicare Part D PDP plans in HI cover DISULFIRAM 500 MG TABLET [Antabuse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIVALPROEX DR 125 MG CAPSULE SPRNK ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX DR 125 MG CAPSULE SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIVALPROEX SOD DR 125 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX SOD DR 125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX SOD DR 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX SOD DR 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DIVALPROEX SOD ER 250 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX SOD ER 250 MG TABLET ER 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in HI cover DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in HI cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in HI cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in HI cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOLISHALE 90-20 MCG TABLET [Lybrel] ![Compare how all Medicare Part D PDP plans in HI cover DOLISHALE 90-20 MCG TABLET [Lybrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:60 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:30 /30Days |
DORZOLAMIDE HCL 2% EYE DROPS [Trusopt] ![Compare how all Medicare Part D PDP plans in HI cover DORZOLAMIDE HCL 2% EYE DROPS [Trusopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
Dorzolamide Hydrochloride and Timolol Maleate 20; 5mg/mL; mg/mL 1 BOTTLE, DROPPER in 1 BOX / 10 mL ![Compare how all Medicare Part D PDP plans in HI 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) |
2* |
Generic |
$2.00 | $0.00 | None |
DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in HI cover DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:8 /28Days |
DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in HI cover DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:8 /28Days |
DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in HI cover DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:8 /28Days |
DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in HI cover DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:8 /28Days |
DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in HI cover DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:8 /28Days |
DOVATO 50-300 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DOVATO 50-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 1 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in HI cover DOXAZOSIN MESYLATE 1 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:30 /30Days |
DOXAZOSIN MESYLATE 2 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in HI cover DOXAZOSIN MESYLATE 2 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:30 /30Days |
DOXAZOSIN MESYLATE 4 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in HI cover DOXAZOSIN MESYLATE 4 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:30 /30Days |
DOXAZOSIN MESYLATE 8 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in HI cover DOXAZOSIN MESYLATE 8 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | Q:60 /30Days |
DOXEPIN 10 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN 10 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXEPIN 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXEPIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXEPIN HCL 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN HCL 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in HI cover DOXEPIN HYDROCHLORIDE CAPSULES 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
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 HI cover DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in HI cover DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in HI cover DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in HI cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in HI cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin] ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs] ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXYCYCLINE HYCLATE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE HYCLATE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DOXYCYCLINE MONO 100 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 100 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXYCYCLINE MONO 50 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 50 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DRIZALMA SPRINKLE DR 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DRIZALMA SPRINKLE DR 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DRIZALMA SPRINKLE DR 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DRIZALMA SPRINKLE DR 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DRIZALMA SPRINKLE DR 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DRIZALMA SPRINKLE DR 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:90 /30Days |
DRIZALMA SPRINKLE DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DRIZALMA SPRINKLE DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | Q:60 /30Days |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in HI cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in HI cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in HI cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROSP-EE-LEVOMEF 3-0.02-0.451 [Beyaz, Safyral] ![Compare how all Medicare Part D PDP plans in HI cover DROSP-EE-LEVOMEF 3-0.02-0.451 [Beyaz, Safyral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DROSPIRENONE-EE 3-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DROSPIRENONE-EE 3-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine] ![Compare how all Medicare Part D PDP plans in HI cover DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | None |
DROXIDOPA 100 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in HI cover DROXIDOPA 100 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:90 /30Days |
DROXIDOPA 200 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in HI cover DROXIDOPA 200 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:180 /30Days |
DROXIDOPA 300 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in HI cover DROXIDOPA 300 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P Q:180 /30Days |
DUAVEE 0.45-20 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover DUAVEE 0.45-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
50% | 50% | P |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in HI cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | 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 [Cymbalta] ![Compare how all Medicare Part D PDP plans in HI cover DULOXETINE HCL DR 30 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:60 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in HI cover DULOXETINE HCL DR 60 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | Q:60 /30Days |
DUPIXENT 200 MG/1.14 ML SYRINGE ![Compare how all Medicare Part D PDP plans in HI cover DUPIXENT 200 MG/1.14 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:5 /28Days |
DUPIXENT 300 MG/2 ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in HI cover DUPIXENT 300 MG/2 ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
DUPIXENT 300 MG/2 ML SAFE SYRINGE ![Compare how all Medicare Part D PDP plans in HI cover DUPIXENT 300 MG/2 ML SAFE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:8 /28Days |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in HI cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$30.00 | $90.00 | None |
DUTASTERIDE 0.5 MG CAPSULE [Avodart] ![Compare how all Medicare Part D PDP plans in HI cover DUTASTERIDE 0.5 MG CAPSULE [Avodart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$2.00 | $0.00 | None |