2024 Medicare Part D Plan Formulary Information |
Humana Basic Rx Plan (PDP) (S5884-113-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Humana Basic Rx Plan (PDP). 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 Humana Basic Rx Plan (PDP) (S5884-113-0) Formulary Drugs Starting with the Letter L in CMS PDP Region 30 which includes: OR WA
|
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LABETALOL HCL 200 MG TABLET [Trandate] ![Compare how all Medicare Part D PDP plans in OR cover LABETALOL HCL 200 MG TABLET [Trandate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LABETALOL HCL 300 MG TABLET [Trandate] ![Compare how all Medicare Part D PDP plans in OR cover LABETALOL HCL 300 MG TABLET [Trandate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LACOSAMIDE 10 MG/ML SOLUTION [Vimpat] ![Compare how all Medicare Part D PDP plans in OR cover LACOSAMIDE 10 MG/ML SOLUTION [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:1395 /30Days |
LACOSAMIDE 100 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in OR cover LACOSAMIDE 100 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LACOSAMIDE 150 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in OR cover LACOSAMIDE 150 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LACOSAMIDE 200 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in OR cover LACOSAMIDE 200 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LACOSAMIDE 50 MG TABLET [Vimpat] ![Compare how all Medicare Part D PDP plans in OR cover LACOSAMIDE 50 MG TABLET [Vimpat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LACTULOSE 10 GM/15 ML SOLUTION [Generlac] ![Compare how all Medicare Part D PDP plans in OR cover LACTULOSE 10 GM/15 ML SOLUTION [Generlac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Lagevrio 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover Lagevrio 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:40 /5Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir] ![Compare how all Medicare Part D PDP plans in OR cover LAMIVUDINE 10 MG/ML ORAL SOLUTION [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:900 /30Days |
LAMIVUDINE 150 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in OR cover LAMIVUDINE 150 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:60 /30Days |
LAMIVUDINE 300 MG TABLET [Epivir] ![Compare how all Medicare Part D PDP plans in OR cover LAMIVUDINE 300 MG TABLET [Epivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:30 /30Days |
LAMIVUDINE HBV 100 MG TABLET [Epivir HBV] ![Compare how all Medicare Part D PDP plans in OR cover LAMIVUDINE HBV 100 MG TABLET [Epivir HBV].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:90 /30Days |
LAMIVUDINE-ZIDOVUDINE TABLET [Combivir] ![Compare how all Medicare Part D PDP plans in OR cover LAMIVUDINE-ZIDOVUDINE TABLET [Combivir].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LAMOTRIGINE 100 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 100 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 150 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 150 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 200 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 200 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 25 MG DISPER TABLET CHEWABLE [Lamictal CD] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 25 MG DISPER TABLET CHEWABLE [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 25 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 25 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHEWABLE [Lamictal CD] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE 5 MG DISPER TABLET CHEWABLE [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ER 100 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 100 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ER 200 MG TABLET 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 200 MG TABLET 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ER 25 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 25 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ER 250 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 250 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ER 300 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 300 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ER 50 MG TABLET ER 24 [Lamictal XR] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ER 50 MG TABLET ER 24 [Lamictal XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT KIT (BLUE) TB RD DSPK [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT KIT (BLUE) TB RD DSPK [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ODT KIT (GREEN) TB RD DSPK [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT KIT (GREEN) TB RD DSPK [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE ODT KIT (ORANGE) TB RD DSPK [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE ODT KIT (ORANGE) TB RD DSPK [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMOTRIGINE START KIT-BLUE TABLET DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE START KIT-BLUE TABLET DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE START KIT-GREEN TABLET DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE START KIT-GREEN TABLET DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMOTRIGINE START KIT-ORANG TABLET DS PK [Subvenite] ![Compare how all Medicare Part D PDP plans in OR cover LAMOTRIGINE START KIT-ORANG TABLET DS PK [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LAMPIT 120 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LAMPIT 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAMPIT 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LAMPIT 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LAPATINIB 250 MG TABLET [Tykerb] ![Compare how all Medicare Part D PDP plans in OR cover LAPATINIB 250 MG TABLET [Tykerb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:180 /30Days |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in OR cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:5 /25Days |
LEENA 28 TABLET [Tri-Norinyl] ![Compare how all Medicare Part D PDP plans in OR cover LEENA 28 TABLET [Tri-Norinyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEFLUNOMIDE 10 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in OR cover LEFLUNOMIDE 10 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:30 /30Days |
LEFLUNOMIDE 20 MG TABLET [Arava] ![Compare how all Medicare Part D PDP plans in OR cover LEFLUNOMIDE 20 MG TABLET [Arava].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:30 /30Days |
LENALIDOMIDE 10 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 10 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 15 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 15 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 2.5 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 2.5 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 20 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 20 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 25 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 25 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
LENALIDOMIDE 5 MG CAPSULE [Revlimid] ![Compare how all Medicare Part D PDP plans in OR cover LENALIDOMIDE 5 MG CAPSULE [Revlimid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LENVIMA 12 MG DAILY DOSE CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 12 MG DAILY DOSE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LENVIMA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in OR cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in OR cover Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LETROZOLE 2.5 MG TABLET [Femara] ![Compare how all Medicare Part D PDP plans in OR cover LETROZOLE 2.5 MG TABLET [Femara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover LEUCOVORIN CALCIUM 15MG 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEUCOVORIN CALCIUM 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEUCOVORIN CALCIUM 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEUCOVORIN CALCIUM 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEUCOVORIN CALCIUM 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in OR cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEUPROLIDE DEPOT 22.5 MG VIAL ![Compare how all Medicare Part D PDP plans in OR cover LEUPROLIDE DEPOT 22.5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:1 /90Days |
LEVETIRACETAM 1,000 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM 1,000 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM 100 MG/ML SOLUTION [Keppra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM 100 MG/ML SOLUTION [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM 250 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM 250 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM 500 MG TABLET [Roweepra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM 500 MG TABLET [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVETIRACETAM 750 MG TABLET [Keppra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM 750 MG TABLET [Keppra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM ER 500 MG TABLET 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM ER 500 MG TABLET 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:180 /30Days |
LEVETIRACETAM ER 750 MG TABLET 24H [Roweepra] ![Compare how all Medicare Part D PDP plans in OR cover LEVETIRACETAM ER 750 MG TABLET 24H [Roweepra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:120 /30Days |
LEVOBUNOLOL 0.5% EYE DROPS [Betagan] ![Compare how all Medicare Part D PDP plans in OR cover LEVOBUNOLOL 0.5% EYE DROPS [Betagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOCARNITINE 1 G/10 ML SOLUTION [Carnitor] ![Compare how all Medicare Part D PDP plans in OR cover LEVOCARNITINE 1 G/10 ML SOLUTION [Carnitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVOCARNITINE 330 MG TABLET [Carnitor] ![Compare how all Medicare Part D PDP plans in OR cover LEVOCARNITINE 330 MG TABLET [Carnitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour] ![Compare how all Medicare Part D PDP plans in OR cover LEVOCETIRIZINE 5 MG TABLET [Xyzal Allergy 24 Hour].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LEVOFLOXACIN 25 MG/ML SOLUTION [Levaquin] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 25 MG/ML SOLUTION [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOFLOXACIN 500 MG TABLET [Levaquin] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 500 MG TABLET [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOFLOXACIN 500 MG/100 ML-D5W PIGGYBACK [Levaquin] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 500 MG/100 ML-D5W PIGGYBACK [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 750 MG TABLET [Levaquin Leva-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 750 MG/150 ML-D5W PIGGYBACK [Levaquin] ![Compare how all Medicare Part D PDP plans in OR cover LEVOFLOXACIN 750 MG/150 ML-D5W PIGGYBACK [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVONO-E ESTRAD 0.10-0.02-0.01 TBDSPK 3MO [LoSeasonique] ![Compare how all Medicare Part D PDP plans in OR cover LEVONO-E ESTRAD 0.10-0.02-0.01 TBDSPK 3MO [LoSeasonique].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:91 /90Days |
LEVONOR-ETH ESTRAD 0.1-0.02 MG TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in OR cover LEVONOR-ETH ESTRAD 0.1-0.02 MG TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in OR cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in OR cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:91 /90Days |
LEVONOR-ETH ESTRAD TRIPHASIC TABLET [Trivora] ![Compare how all Medicare Part D PDP plans in OR cover LEVONOR-ETH ESTRAD TRIPHASIC TABLET [Trivora].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVORA-28 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVORA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 125 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 125 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 200 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 200 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 300 MCG TABLET [Unithroid] ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 300 MCG TABLET [Unithroid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:1575 /28Days |
LIDOCAINE 2% VISCOUS SOLUTION [Xylocaine Viscous] ![Compare how all Medicare Part D PDP plans in OR cover LIDOCAINE 2% VISCOUS SOLUTION [Xylocaine Viscous].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIDOCAINE 5% PATCH [Lidoderm] ![Compare how all Medicare Part D PDP plans in OR cover LIDOCAINE 5% PATCH [Lidoderm].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:90 /30Days |
LIDOCAINE-PRILOCAINE CREAM (G) [SOLUPICC] ![Compare how all Medicare Part D PDP plans in OR cover LIDOCAINE-PRILOCAINE CREAM (G) [SOLUPICC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox Powder] ![Compare how all Medicare Part D PDP plans in OR cover LINEZOLID 100 MG/5 ML ORAL SUSPENSION [Zyvox Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:1800 /30Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in OR cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:60 /30Days |
LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox] ![Compare how all Medicare Part D PDP plans in OR cover LINEZOLID 600 MG/300 ML-D5W PIGGYBACK [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:30 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:30 /30Days |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:30 /30Days |
LIOTHYRONINE SOD 25 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in OR cover LIOTHYRONINE SOD 25 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LIOTHYRONINE SOD 5 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in OR cover LIOTHYRONINE SOD 5 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in OR cover LIOTHYRONINE SOD 50 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL 40 MG TABLET [Zestril] ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 40 MG TABLET [Zestril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL-HCTZ 10-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL-HCTZ 20-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LISINOPRIL-HCTZ 20-25 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LISINOPRIL-HCTZ 20-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM 8 MEQ/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM 8 MEQ/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LITHIUM CARBONATE 150 MG CAPSULE CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE 150 MG CAPSULE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHIUM CARBONATE 300 MG CAPSULE [Eskalith] ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE 300 MG CAPSULE [Eskalith].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LITHIUM CARBONATE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE 600 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE 600 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR] ![Compare how all Medicare Part D PDP plans in OR cover LITHIUM CARBONATE ER 450 MG TABLET [Eskalith CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LITHOSTAT 250 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LITHOSTAT 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOESTRIN 21 1.5/30 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOESTRIN 21 1.5/30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOESTRIN 21 1/20 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOESTRIN 21 1/20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOESTRIN FE 1.5/30 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOESTRIN FE 1.5/30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOESTRIN FE 1/20 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOESTRIN FE 1/20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:100 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:80 /30Days |
LOPERAMIDE 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover LOPERAMIDE 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in OR cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOPINAVIR-RITONAVR 100-25MG TABLET [Kaletra] ![Compare how all Medicare Part D PDP plans in OR cover LOPINAVIR-RITONAVR 100-25MG TABLET [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:300 /30Days |
LOPINAVIR-RITONAVR 200-50MG TABLET [Kaletra] ![Compare how all Medicare Part D PDP plans in OR cover LOPINAVIR-RITONAVR 200-50MG TABLET [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:150 /30Days |
LORAZEPAM 0.5 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in OR cover LORAZEPAM 0.5 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:90 /30Days |
LORAZEPAM 1 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in OR cover LORAZEPAM 1 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:90 /30Days |
LORAZEPAM 2 MG TABLET [Ativan] ![Compare how all Medicare Part D PDP plans in OR cover LORAZEPAM 2 MG TABLET [Ativan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:150 /30Days |
LORAZEPAM INTENSOL 2 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in OR cover LORAZEPAM INTENSOL 2 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:150 /30Days |
LORBRENA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LORBRENA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LORBRENA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LORBRENA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in OR cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOSARTAN POTASSIUM 100 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN POTASSIUM 100 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN POTASSIUM 25 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN POTASSIUM 25 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN POTASSIUM 50 MG TABLET [Cozaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN POTASSIUM 50 MG TABLET [Cozaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN-HCTZ 100-12.5 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 100-25 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN-HCTZ 100-25 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOSARTAN-HCTZ 50-12.5 MG TABLET [Hyzaar] ![Compare how all Medicare Part D PDP plans in OR cover LOSARTAN-HCTZ 50-12.5 MG TABLET [Hyzaar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LOTEMAX SM 0.38% OPHTH GEL DROPS ![Compare how all Medicare Part D PDP plans in OR cover LOTEMAX SM 0.38% OPHTH GEL DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
LOVASTATIN 40 MG TABLET [Mevacor] ![Compare how all Medicare Part D PDP plans in OR cover LOVASTATIN 40 MG TABLET [Mevacor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$0.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOW-OGESTREL-28 TABLET [Low-Ogestrel] ![Compare how all Medicare Part D PDP plans in OR cover LOW-OGESTREL-28 TABLET [Low-Ogestrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LOXAPINE 10 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in OR cover LOXAPINE 10 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOXAPINE 25 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in OR cover LOXAPINE 25 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOXAPINE 5 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in OR cover LOXAPINE 5 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LOXAPINE 50 MG CAPSULE [Loxitane] ![Compare how all Medicare Part D PDP plans in OR cover LOXAPINE 50 MG CAPSULE [Loxitane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | None |
LUBIPROSTONE 24 MCG CAPSULE [Amitiza] ![Compare how all Medicare Part D PDP plans in OR cover LUBIPROSTONE 24 MCG CAPSULE [Amitiza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:60 /30Days |
LUBIPROSTONE 8 MCG CAPSULE [Amitiza] ![Compare how all Medicare Part D PDP plans in OR cover LUBIPROSTONE 8 MCG CAPSULE [Amitiza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:60 /30Days |
LUMAKRAS 120 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LUMAKRAS 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:240 /30Days |
LUMAKRAS 320 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LUMAKRAS 320 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in OR cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
24% | 15% | Q:3 /25Days |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:1 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:1 /90Days |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:1 /30Days |
LUPRON DEPOT 45 MG 6MO KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT 45 MG 6MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:1 /168Days |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:1 /30Days |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:1 /112Days |
LUPRON DEPOT-PED 11.25 MG 3MO SYRINGE KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT-PED 11.25 MG 3MO SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:1 /90Days |
LUPRON DEPOT-PED 45 MG 6MO SYRINGE KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT-PED 45 MG 6MO SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:1 /168Days |
LUPRON DEPOT-PED 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in OR cover LUPRON DEPOT-PED 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:1 /28Days |
LURASIDONE HCL 120 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in OR cover LURASIDONE HCL 120 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LURASIDONE HCL 20 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in OR cover LURASIDONE HCL 20 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LURASIDONE HCL 40 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in OR cover LURASIDONE HCL 40 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LURASIDONE HCL 60 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in OR cover LURASIDONE HCL 60 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:30 /30Days |
LURASIDONE HCL 80 MG TABLET [Latuda] ![Compare how all Medicare Part D PDP plans in OR cover LURASIDONE HCL 80 MG TABLET [Latuda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$1.00 | $0.00 | Q:60 /30Days |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in OR cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LYBALVI 10-10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYBALVI 10-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:30 /30Days |
LYBALVI 15-10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYBALVI 15-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:30 /30Days |
LYBALVI 20-10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYBALVI 20-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | P Q:30 /30Days |
LYBALVI 5-10 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYBALVI 5-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
LYLEQ 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in OR cover LYLEQ 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |
LYLLANA 0.025 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in OR cover LYLLANA 0.025 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:8 /28Days |
LYLLANA 0.0375 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in OR cover LYLLANA 0.0375 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:8 /28Days |
LYLLANA 0.05 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in OR cover LYLLANA 0.05 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYLLANA 0.075 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in OR cover LYLLANA 0.075 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:8 /28Days |
LYLLANA 0.1 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in OR cover LYLLANA 0.1 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | Q:8 /28Days |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
LYSODREN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYSODREN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LYTGOBI 12 MG DOSE (3X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYTGOBI 12 MG DOSE (3X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:140 /28Days |
LYTGOBI 16 MG DOSE (4X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYTGOBI 16 MG DOSE (4X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:140 /28Days |
LYTGOBI 20 MG DOSE (5X 4MG TB) TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYTGOBI 20 MG DOSE (5X 4MG TB) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:140 /28Days |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 30% | None |