2024 Medicare Part D Plan Formulary Information |
HumanaChoice H5525-067 (PPO) (H5525-067-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for HumanaChoice H5525-067 (PPO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. Call drug plan for more details. |
The HumanaChoice H5525-067 (PPO) (H5525-067-0) Formulary Drugs Starting with the Letter D in Harding County, SD: CMS MA Region 19 which includes: SD
|
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 |
DABIGATRAN ETEXILATE 110 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in SD cover DABIGATRAN ETEXILATE 110 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days |
DABIGATRAN ETEXILATE 150 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in SD cover DABIGATRAN ETEXILATE 150 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days |
DABIGATRAN ETEXILATE 75 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in SD cover DABIGATRAN ETEXILATE 75 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days |
DALFAMPRIDINE ER 10 MG TABLET 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in SD cover DALFAMPRIDINE ER 10 MG TABLET 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | P Q:60 /30Days |
DANAZOL 100 MG CAPSULE [Danocrine] ![Compare how all Medicare Part D PDP plans in SD cover DANAZOL 100 MG CAPSULE [Danocrine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAPSONE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DAPSONE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DAPTACEL DTAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in SD cover DAPTACEL DTAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in SD cover DAPTOMYCIN 350 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DAPTOMYCIN 500 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in SD cover DAPTOMYCIN 500 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | None |
DARIFENACIN ER 15 MG TABLET ER 24H [Enablex] ![Compare how all Medicare Part D PDP plans in SD cover DARIFENACIN ER 15 MG TABLET ER 24H [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days |
DARIFENACIN ER 7.5 MG TABLET ER 24H [Enablex] ![Compare how all Medicare Part D PDP plans in SD cover DARIFENACIN ER 7.5 MG TABLET ER 24H [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:30 /30Days |
DARUNAVIR 600 MG TABLET [Prezista] ![Compare how all Medicare Part D PDP plans in SD cover DARUNAVIR 600 MG TABLET [Prezista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:60 /30Days |
DARUNAVIR 800 MG TABLET [Prezista] ![Compare how all Medicare Part D PDP plans in SD cover DARUNAVIR 800 MG TABLET [Prezista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:30 /30Days |
DAURISMO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DAURISMO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:30 /30Days |
DAURISMO 25 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DAURISMO 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | 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 SD cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DEFERASIROX 180 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in SD cover DEFERASIROX 180 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DEFERASIROX 360 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in SD cover DEFERASIROX 360 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P |
DEFERASIROX 90 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in SD cover DEFERASIROX 90 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | P |
DELSTRIGO 100-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DELSTRIGO 100-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:30 /30Days |
DEMECLOCYCLINE 150 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in SD cover DEMECLOCYCLINE 150 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:240 /30Days |
DEMECLOCYCLINE 300 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in SD cover DEMECLOCYCLINE 300 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:120 /30Days |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in SD cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in SD cover Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:0.65 /90Days |
DESCOVY 120-15 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DESCOVY 120-15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:30 /30Days |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in SD cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in SD cover DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in SD cover DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea] ![Compare how all Medicare Part D PDP plans in SD cover DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia] ![Compare how all Medicare Part D PDP plans in SD cover DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESVENLAFAXINE SUCCNT ER 100MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in SD cover DESVENLAFAXINE SUCCNT ER 100MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DESVENLAFAXINE SUCCNT ER 25 MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in SD cover DESVENLAFAXINE SUCCNT ER 25 MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DESVENLAFAXINE SUCCNT ER 50 MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in SD cover DESVENLAFAXINE SUCCNT ER 50 MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 0.5 MG/5 ML LIQ SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 0.5 MG/5 ML LIQ SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $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 SD cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXMETHYLPHENIDATE 10 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in SD cover DEXMETHYLPHENIDATE 10 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in SD cover DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXMETHYLPHENIDATE 5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in SD cover DEXMETHYLPHENIDATE 5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 10 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 10 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 15 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 15 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DEXTROAMP-AMPHET ER 20 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 20 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 25 MG CAPSULE 24H [Mydayis] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 25 MG CAPSULE 24H [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 30 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 30 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMP-AMPHET ER 5 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHET ER 5 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DEXTROAMP-AMPHETAMIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHETAMIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHETAMIN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMP-AMPHETAMIN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:180 /30Days |
DEXTROAMPHETAMINE 15 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE 15 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:120 /30Days |
DEXTROAMPHETAMINE 20 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE 20 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:90 /30Days |
DEXTROAMPHETAMINE 30 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE 30 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:60 /30Days |
DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:150 /30Days |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE 10%-WATER IV SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 10%-WATER IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE 5%-0.2% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 5%-0.2% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROSE 5%-0.45% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 5%-0.45% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE 5%-0.9% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 5%-0.9% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE 5%-WATER IV SOLUTION PGY VL PRT ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE 5%-WATER IV SOLUTION PGY VL PRT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in SD cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DIACOMIT 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DIACOMIT 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:180 /30Days |
DIACOMIT 250 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in SD cover DIACOMIT 250 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:180 /30Days |
DIACOMIT 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DIACOMIT 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:180 /30Days |
DIACOMIT 500 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in SD cover DIACOMIT 500 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:180 /30Days |
DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:120 /30Days |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in SD 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 |
$100.00 | $290.00 | None |
DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:90 /30Days |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:1200 /30Days |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in SD cover DIAZEPAM 5 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | Q:240 /30Days |
DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem] ![Compare how all Medicare Part D PDP plans in SD cover DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DICLOFENAC 0.1% EYE DROPS [Voltaren Ophthalmic] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC 0.1% EYE DROPS [Voltaren Ophthalmic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICLOFENAC EPOLAMINE 1.3% PATCH TD12 [Licart] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC EPOLAMINE 1.3% PATCH TD12 [Licart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days |
DICLOFENAC SOD EC 25 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SOD EC 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DICLOFENAC SOD EC 50 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SOD EC 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SOD EC 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICLOFENAC SODIUM 1% GEL [Voltaren Gel] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SODIUM 1% GEL [Voltaren Gel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:1000 /30Days |
DICLOFENAC SODIUM 3% GEL [Solaraze] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC SODIUM 3% GEL [Solaraze].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | P |
DICLOFENAC-MISOPROST 50-200 TABLET IR DR [Arthrotec] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC-MISOPROST 50-200 TABLET IR DR [Arthrotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DICLOFENAC-MISOPROST 75-200 TABLET IR DR [Arthrotec] ![Compare how all Medicare Part D PDP plans in SD cover DICLOFENAC-MISOPROST 75-200 TABLET IR DR [Arthrotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DICLOXACILLIN SODIUM 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE [Bentyl] ![Compare how all Medicare Part D PDP plans in SD cover DICYCLOMINE 10 MG CAPSULE [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICYCLOMINE 20 MG TABLET [Bentyl] ![Compare how all Medicare Part D PDP plans in SD cover DICYCLOMINE 20 MG TABLET [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in SD cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in SD 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 |
Tier 5 |
28% | N/A | None |
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 SD cover DIFICID 40 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in SD cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in SD cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days |
DIHYDROERGOTAMINE 4 MG/ML SPRAY/PUMP [TRUDHESA] ![Compare how all Medicare Part D PDP plans in SD cover DIHYDROERGOTAMINE 4 MG/ML SPRAY/PUMP [TRUDHESA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:8 /30Days |
DILANTIN 125 MG/5 ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in SD cover DILANTIN 125 MG/5 ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in SD cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:90 /30Days |
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 SD cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:180 /30Days |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:180 /30Days |
DILTIAZEM 24H ER(CD) 120 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24H ER(CD) 120 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24H ER(CD) 180 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24H ER(CD) 180 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24H ER(CD) 240 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24H ER(CD) 240 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DILTIAZEM 24H ER(CD) 300 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24H ER(CD) 300 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days |
DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days |
DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:30 /30Days |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in SD cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in SD cover DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:60 /30Days |
DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in SD cover DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:14 /30Days |
DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in SD cover DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | 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 SD 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) |
1* |
Preferred Generic |
$0.00 | $0.00 | 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 SD 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) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro] ![Compare how all Medicare Part D PDP plans in SD 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 |
$100.00 | $290.00 | None |
Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension ![Compare how all Medicare Part D PDP plans in SD 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) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
DIPYRIDAMOLE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DIPYRIDAMOLE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIPYRIDAMOLE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DIPYRIDAMOLE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIPYRIDAMOLE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DIPYRIDAMOLE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DISULFIRAM 500 MG TABLET [Antabuse] ![Compare how all Medicare Part D PDP plans in SD cover DISULFIRAM 500 MG TABLET [Antabuse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in SD cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DIVALPROEX DR 125 MG CAPSULE SPRNK ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX DR 125 MG CAPSULE SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DIVALPROEX SOD DR 125 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX SOD DR 125 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX SOD DR 250 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX SOD DR 500 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DIVALPROEX SOD ER 250 MG TABLET 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX SOD ER 250 MG TABLET 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in SD cover DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in SD cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in SD cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in SD cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | 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 SD cover DOLISHALE 90-20 MCG TABLET [Lybrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:60 /30Days |
DONEPEZIL HCL 23 MG TABLET [Aricept] ![Compare how all Medicare Part D PDP plans in SD cover DONEPEZIL HCL 23 MG TABLET [Aricept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | Q:30 /30Days |
DORZOLAMIDE HCL 2% EYE DROPS [Trusopt] ![Compare how all Medicare Part D PDP plans in SD cover DORZOLAMIDE HCL 2% EYE DROPS [Trusopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
DORZOLAMIDE-TIMOLOL EYE DROPS [Cosopt PF] ![Compare how all Medicare Part D PDP plans in SD cover DORZOLAMIDE-TIMOLOL EYE DROPS [Cosopt PF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | $0.00 | None |
DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in SD cover DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:8 /28Days |
DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in SD cover DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:8 /28Days |
DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in SD cover DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in SD cover DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:8 /28Days |
DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in SD cover DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:8 /28Days |
DOVATO 50-300 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DOVATO 50-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | Q:30 /30Days |
DOXAZOSIN MESYLATE 1 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in SD cover DOXAZOSIN MESYLATE 1 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXAZOSIN MESYLATE 2 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in SD cover DOXAZOSIN MESYLATE 2 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXAZOSIN MESYLATE 4 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in SD cover DOXAZOSIN MESYLATE 4 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXAZOSIN MESYLATE 8 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in SD cover DOXAZOSIN MESYLATE 8 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXEPIN 10 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 10 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXEPIN 10 MG/ML ORAL CONC [Sinequan] ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 10 MG/ML ORAL CONC [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXEPIN 100 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 100 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXEPIN 25 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 25 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXEPIN 50 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 50 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in SD cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in SD cover DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in SD cover DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in SD cover DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in SD cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in SD cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin] ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs] ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE HYCLATE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE HYCLATE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE MONO 100 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE MONO 100 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE MONO 50 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE MONO 50 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | None |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in SD cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in SD cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in SD cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:120 /30Days |
DROSPIRENONE-EE 3-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DROSPIRENONE-EE 3-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine] ![Compare how all Medicare Part D PDP plans in SD cover DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in SD cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | None |
DUAVEE 0.45-20 MG TABLET ![Compare how all Medicare Part D PDP plans in SD cover DUAVEE 0.45-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $290.00 | P Q:30 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in SD cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:120 /30Days |
DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in SD cover DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:90 /30Days |
DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in SD cover DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $0.00 | Q:60 /30Days |
DUPIXENT 100 MG/0.67 ML SYRINGE ![Compare how all Medicare Part D PDP plans in SD cover DUPIXENT 100 MG/0.67 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:1.34 /28Days |
DUPIXENT 200 MG/1.14 ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in SD cover DUPIXENT 200 MG/1.14 ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:3.42 /28Days |
DUPIXENT 200 MG/1.14 ML SYRINGE ![Compare how all Medicare Part D PDP plans in SD cover DUPIXENT 200 MG/1.14 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:3.42 /28Days |
DUPIXENT 300 MG/2 ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in SD cover DUPIXENT 300 MG/2 ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUPIXENT 300 MG/2 ML SAFE SYRINGE ![Compare how all Medicare Part D PDP plans in SD cover DUPIXENT 300 MG/2 ML SAFE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
28% | N/A | P Q:8 /28Days |
DUTASTERIDE 0.5 MG CAPSULE [Avodart] ![Compare how all Medicare Part D PDP plans in SD cover DUTASTERIDE 0.5 MG CAPSULE [Avodart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn] ![Compare how all Medicare Part D PDP plans in SD cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |