2022 Medicare Part D Plan Formulary Information |
Anthem MediBlue Preferred Plus (HMO) (H3655-042-0)
Benefit Details
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The Anthem MediBlue Preferred Plus (HMO) (H3655-042-0) Formulary Drugs Starting with the Letter D in Fairfield County, OH: CMS MA Region 12 which includes: OH
|
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 SOLUTION ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
D5%-1/2NS-KCL 30 MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
D5%-1/2NS-KCL 40 MEQ/L IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in OH cover DALFAMPRIDINE ER 10 MG TABLET ER 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
DALIRESP 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DALIRESP 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days |
DALIRESP 500 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DALIRESP 500 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days |
DANAZOL 100 MG CAPSULE [Danocrine] ![Compare how all Medicare Part D PDP plans in OH cover DANAZOL 100 MG CAPSULE [Danocrine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DAPSONE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DAPSONE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DAPTACEL DTAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in OH cover DAPTACEL DTAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in OH 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 RF] ![Compare how all Medicare Part D PDP plans in OH cover DAPTOMYCIN 500 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DAURISMO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH 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 OH 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 |
DEBLITANE 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DEFERASIROX 125 MG TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in OH cover DEFERASIROX 125 MG TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEFERASIROX 250 MG TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in OH cover DEFERASIROX 250 MG TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
DEFERASIROX 500 MG TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in OH cover DEFERASIROX 500 MG TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
DELESTROGEN INJECTION 10MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in OH cover DELESTROGEN INJECTION 10MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DELSTRIGO 100-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in OH 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 |
DEMECLOCYCLINE 150 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in OH cover DEMECLOCYCLINE 150 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEMECLOCYCLINE 300 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in OH cover DEMECLOCYCLINE 300 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEMSER CAPSULES 250MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DEMSER CAPSULES 250MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
DENAVIR 1% CREAM (g) ![Compare how all Medicare Part D PDP plans in OH cover DENAVIR 1% CREAM (g).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:5 /30Days |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH 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 |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in OH cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DESLORATADINE 2.5 MG ODDT ![Compare how all Medicare Part D PDP plans in OH cover DESLORATADINE 2.5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DESLORATADINE 5 MG ODDT ![Compare how all Medicare Part D PDP plans in OH cover DESLORATADINE 5 MG ODDT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DESMOPRESSIN 10 MCG/0.1 ML SPR SPRAY/PUMP [Minirin] ![Compare how all Medicare Part D PDP plans in OH cover DESMOPRESSIN 10 MCG/0.1 ML SPR SPRAY/PUMP [Minirin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in OH cover DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in OH cover DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea] ![Compare how all Medicare Part D PDP plans in OH cover DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia] ![Compare how all Medicare Part D PDP plans in OH cover DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DESONIDE 0.05% CREAM (G) [Tridesilon] ![Compare how all Medicare Part D PDP plans in OH cover DESONIDE 0.05% CREAM (G) [Tridesilon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DESONIDE 0.05% LOTION [LoKara] ![Compare how all Medicare Part D PDP plans in OH cover DESONIDE 0.05% LOTION [LoKara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DESONIDE 0.05% OINTMENT [Tridesilon] ![Compare how all Medicare Part D PDP plans in OH cover DESONIDE 0.05% OINTMENT [Tridesilon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DESOXIMETASONE 0.05% CREAM (G) [Topicort LP] ![Compare how all Medicare Part D PDP plans in OH cover DESOXIMETASONE 0.05% CREAM (G) [Topicort LP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:100 /30Days |
DESOXIMETASONE 0.25% CREAM ![Compare how all Medicare Part D PDP plans in OH cover DESOXIMETASONE 0.25% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:100 /30Days |
DESOXIMETASONE 0.25% OINTMENT [Topicort] ![Compare how all Medicare Part D PDP plans in OH cover DESOXIMETASONE 0.25% OINTMENT [Topicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
DESVENLAFAXINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DESVENLAFAXINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
DESVENLAFAXINE ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DESVENLAFAXINE ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESVENLAFAXINE SUC ER 100 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in OH cover DESVENLAFAXINE SUC ER 100 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DESVENLAFAXINE SUC ER 25 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in OH cover DESVENLAFAXINE SUC ER 25 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DESVENLAFAXINE SUCCNT ER 50 MG TABLET ER 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in OH cover DESVENLAFAXINE SUCCNT ER 50 MG TABLET ER 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 0.5 MG/5 ML ELIXIR [Decadron] ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 0.5 MG/5 ML ELIXIR [Decadron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DEXILANT CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in OH cover DEXILANT CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | S Q:30 /30Days |
DEXILANT DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DEXILANT DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | S Q:30 /30Days |
DEXLANSOPRAZOLE DR 30 MG CAPSULE BP [Kapidex] ![Compare how all Medicare Part D PDP plans in OH cover DEXLANSOPRAZOLE DR 30 MG CAPSULE BP [Kapidex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | S Q:30 /30Days |
DEXLANSOPRAZOLE DR 60 MG CAPSULE BP [Kapidex] ![Compare how all Medicare Part D PDP plans in OH cover DEXLANSOPRAZOLE DR 60 MG CAPSULE BP [Kapidex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | S Q:30 /30Days |
DEXTROAMP-AMPHET ER 10 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAPSULE ER 24H [Mydayis] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAPSULE ER 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHETAMIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXTROAMP-AMPHETAMIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:90 /30Days |
DEXTROAMP-AMPHETAMIN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DEXTROAMP-AMPHETAMIN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in OH cover DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:180 /30Days |
DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in OH cover DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:90 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | P Q:90 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXTROSE 10%-WATER IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 10%-WATER IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXTROSE 5%-0.2% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 5%-0.2% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXTROSE 5%-0.45% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 5%-0.45% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DEXTROSE 5%-0.9% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 5%-0.9% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 5%-WATER IV SOLUTION PIGGYBACK PRT ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE 5%-WATER IV SOLUTION PIGGYBACK PRT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in OH cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIACOMIT 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DIACOMIT 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:360 /30Days |
DIACOMIT 250 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in OH cover DIACOMIT 250 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:360 /30Days |
DIACOMIT 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DIACOMIT 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
DIACOMIT 500 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in OH cover DIACOMIT 500 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
DIASTAT 2.5 MG PEDI SYSTEM ![Compare how all Medicare Part D PDP plans in OH cover DIASTAT 2.5 MG PEDI SYSTEM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIASTAT ACUDIAL 12.5-15-20 MG ![Compare how all Medicare Part D PDP plans in OH cover DIASTAT ACUDIAL 12.5-15-20 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIASTAT ACUDIAL 5-7.5-10 MG KIT ![Compare how all Medicare Part D PDP plans in OH cover DIASTAT ACUDIAL 5-7.5-10 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:600 /30Days |
DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:240 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:1200 /30Days |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in OH cover DIAZEPAM 5 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:240 /30Days |
DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem] ![Compare how all Medicare Part D PDP plans in OH cover DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DICLOFENAC 0.1% EYE DROPS [Voltaren] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC 0.1% EYE DROPS [Voltaren].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICLOFENAC 1.5% TOPICAL SOLUTION DROPS [VOPAC MDS] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC 1.5% TOPICAL SOLUTION DROPS [VOPAC MDS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:300 /30Days |
DICLOFENAC POT 50 MG TABLET [Cataflam] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC POT 50 MG TABLET [Cataflam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICLOFENAC SOD EC 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SOD EC 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC SOD EC 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SOD EC 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SOD EC 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICLOFENAC SODIUM 1% GEL [Voltaren Gel] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SODIUM 1% GEL [Voltaren Gel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | Q:1000 /30Days |
DICLOFENAC SODIUM 3% GEL [Solaraze] ![Compare how all Medicare Part D PDP plans in OH cover DICLOFENAC SODIUM 3% GEL [Solaraze].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:100 /30Days |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DICLOXACILLIN SODIUM 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE [Bentyl] ![Compare how all Medicare Part D PDP plans in OH cover DICYCLOMINE 10 MG CAPSULE [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET [Bentyl] ![Compare how all Medicare Part D PDP plans in OH cover DICYCLOMINE 20 MG TABLET [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in OH cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OH 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 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFICID 40 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in OH cover DIFICID 40 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
DIFLORASONE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in OH cover DIFLORASONE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIFLORASONE 0.05% OINTMENT [Psorcon E] ![Compare how all Medicare Part D PDP plans in OH cover DIFLORASONE 0.05% OINTMENT [Psorcon E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIFLUNISAL 500 MG TABLET [Dolobid] ![Compare how all Medicare Part D PDP plans in OH cover DIFLUNISAL 500 MG TABLET [Dolobid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIFLUPREDNATE 0.05% EYE DROPS [Durezol] ![Compare how all Medicare Part D PDP plans in OH cover DIFLUPREDNATE 0.05% EYE DROPS [Durezol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIGITEK 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DIGITEK 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DIGITEK 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DIGITEK 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DIGOX 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in OH cover DIGOX 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DIGOX 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DIGOX 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin] ![Compare how all Medicare Part D PDP plans in OH cover DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in OH cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in OH cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DIGOXIN 62.5 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in OH cover DIGOXIN 62.5 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in OH 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 /28Days |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in OH cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in OH cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DILTIAZEM 24H ER(LA) 180 MG TABLET ER 24H [Matzim LA] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24H ER(LA) 180 MG TABLET ER 24H [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DILTIAZEM 24H ER(LA) 240 MG TABLET ER 24H [Matzim LA] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24H ER(LA) 240 MG TABLET ER 24H [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DILTIAZEM 24H ER(LA) 300 MG TABLET ER 24H [Matzim LA] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24H ER(LA) 300 MG TABLET ER 24H [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DILTIAZEM 24H ER(LA) 360 MG TABLET ER 24H [Matzim LA] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24H ER(LA) 360 MG TABLET ER 24H [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 180 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 240 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 300 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in OH cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $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 OH cover Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | 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 OH cover Diph-Tetanus Tox-Acell Pert-Hepatitis B-Polio IPV Vac 0.5 ML Prefilled Syringe [Pediarix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro] ![Compare how all Medicare Part D PDP plans in OH cover DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in OH cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | 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 OH 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 |
$42.00 | $84.00 | None |
DISOPYRAMIDE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DISOPYRAMIDE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DISULFIRAM 500 MG TABLET [Antabuse] ![Compare how all Medicare Part D PDP plans in OH cover DISULFIRAM 500 MG TABLET [Antabuse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIVALPROEX DR 125 MG CAPSULE SPRNK ![Compare how all Medicare Part D PDP plans in OH cover DIVALPROEX DR 125 MG CAPSULE SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DIVALPROEX SOD DR 125 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in OH cover DIVALPROEX SOD DR 125 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in OH cover DIVALPROEX SOD DR 250 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in OH cover DIVALPROEX SOD DR 500 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DIVALPROEX SOD ER 250 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in OH 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 |
$95.00 | $190.00 | None |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in OH cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in OH cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in OH cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOLISHALE 90-20 MCG TABLET [Lybrel] ![Compare how all Medicare Part D PDP plans in OH cover DOLISHALE 90-20 MCG TABLET [Lybrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | $0.00 | Q:30 /30Days |
DORZOLAMIDE HCL 2% EYE DROPS [Trusopt] ![Compare how all Medicare Part D PDP plans in OH cover DORZOLAMIDE HCL 2% EYE DROPS [Trusopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $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 OH 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 |
$10.00 | $0.00 | None |
DOVATO 50-300 MG TABLET ![Compare how all Medicare Part D PDP plans in OH 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 |
DOXAZOSIN MESYLATE 1 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in OH cover DOXAZOSIN MESYLATE 1 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXAZOSIN MESYLATE 2 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in OH cover DOXAZOSIN MESYLATE 2 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXAZOSIN MESYLATE 4 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in OH cover DOXAZOSIN MESYLATE 4 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXAZOSIN MESYLATE 8 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in OH cover DOXAZOSIN MESYLATE 8 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXEPIN 10 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 10 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXEPIN 10 MG/ML ORAL CONC [Sinequan] ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 10 MG/ML ORAL CONC [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXEPIN 100 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 100 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXEPIN 25 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 25 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXEPIN 50 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 50 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in OH cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | P |
DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in OH cover DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in OH cover DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in OH cover DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in OH cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in OH cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin] ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs] ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE HYCLATE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE HYCLATE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE MONO 100 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 100 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE MONO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 50 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 50 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$10.00 | $0.00 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DRIZALMA SPRINKLE DR 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DRIZALMA SPRINKLE DR 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:60 /30Days |
DRIZALMA SPRINKLE DR 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DRIZALMA SPRINKLE DR 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
DRIZALMA SPRINKLE DR 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DRIZALMA SPRINKLE DR 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
DRIZALMA SPRINKLE DR 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DRIZALMA SPRINKLE DR 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:60 /30Days |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in OH cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:120 /30Days |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in OH cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:120 /30Days |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in OH cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:120 /30Days |
DROSPIRENONE-EE 3-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DROSPIRENONE-EE 3-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine] ![Compare how all Medicare Part D PDP plans in OH cover DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DROXIDOPA 100 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in OH cover DROXIDOPA 100 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
DROXIDOPA 200 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in OH cover DROXIDOPA 200 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
DROXIDOPA 300 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in OH cover DROXIDOPA 300 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
DUAVEE 0.45-20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DUAVEE 0.45-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P Q:30 /30Days |
DUETACT 30MG-4MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover DUETACT 30MG-4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in OH cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:180 /30Days |
DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in OH cover DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DULOXETINE HCL DR 40 MG CAPSULE [Irenka] ![Compare how all Medicare Part D PDP plans in OH cover DULOXETINE HCL DR 40 MG CAPSULE [Irenka].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:90 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in OH cover DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:60 /30Days |
DUREZOL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in OH cover DUREZOL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | None |
DUTASTERIDE 0.5 MG CAPSULE [Avodart] ![Compare how all Medicare Part D PDP plans in OH cover DUTASTERIDE 0.5 MG CAPSULE [Avodart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | Q:30 /30Days |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn] ![Compare how all Medicare Part D PDP plans in OH cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $84.00 | Q:30 /30Days |