SOUTH DAKOTA MEDICAID MAC LIST
DRUGS THAT START WITH LETTER D


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GENERIC NAME GPI MAC
DACARBAZINE FOR INJ 100 MG 21700020002105 $0.00000
DACARBAZINE FOR INJ 200 MG 21700020002110 $10.00000
DANAZOL CAP 100 MG 23100005000110 $2.22510
DANAZOL CAP 200 MG 23100005000115 $3.00000
DANTROLENE SODIUM CAP 100 MG 75200010100115 $1.56520
DANTROLENE SODIUM CAP 25 MG 75200010100105 $0.70000
DANTROLENE SODIUM CAP 50 MG 75200010100110 $1.31190
DEMECLOCYCLINE HCL TAB 150 MG 04000010100305 $6.90000
DEMECLOCYCLINE HCL TAB 300 MG 04000010100310 $12.38000
DESIPRAMINE HCL TAB 10 MG 58200030100305 $0.59580
DESIPRAMINE HCL TAB 100 MG 58200030100325 $2.17220
DESIPRAMINE HCL TAB 150 MG 58200030100330 $3.13830
DESIPRAMINE HCL TAB 25 MG 58200030100310 $0.76120
DESIPRAMINE HCL TAB 50 MG 58200030100315 $1.56400
DESIPRAMINE HCL TAB 75 MG 58200030100320 $1.67890
DESMOPRESSIN ACETATE INJ 4 MCG/ML 30201010102030 $8.84510
DESMOPRESSIN ACETATE NASAL SOLN 0.01% (REFRIGERATED) 30201010112010 $0.00000
DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01% 30201010132010 $17.00000
DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01% 30201010102050 $0.00000
DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01% (REFRIGE 30201010122010 $14.80000
DESMOPRESSIN ACETATE NASAL SPRAY SOLN 0.01% (REFRIGE 30201010102006 $0.00000
DESMOPRESSIN ACETATE TAB 0.1 MG 30201010100310 $2.10000
DESMOPRESSIN ACETATE TAB 0.2 MG 30201010100320 $1.66000
DESOGEST-ETH ESTRAD & ETH ESTRAD TAB 0.15-0.02/0.01 25990002100365 $1.52160
DESOGEST-ETHIN EST TAB 0.1-0.025/0.125-0.025/0.15-0. 25992002030320 $0.94000
DESOGESTREL & ETHINYL ESTRADIOL TAB 0.15 MG-30 MCG 25990002100320 $0.71000
DESONIDE CREAM 0.05% 90550035003705 $0.00000
DESONIDE CREAM 0.05% 90550035003705 $0.30000
DESONIDE CREAM 0.05% 90550035003705 $0.28000
DESONIDE LOTION 0.05% 90550035004105 $0.00000
DESONIDE OINT 0.05% 90550035004205 $0.36000
DESOXIMETASONE CREAM 0.05% 90550040003705 $2.04160
DESOXIMETASONE CREAM 0.25% 90550040003710 $1.67180
DESOXIMETASONE GEL 0.05% 90550040004005 $2.01660
DESOXIMETASONE OINT 0.25% 90550040004205 $2.45110
DEXAMETHASONE ACETATE INJ SUSP 8 MG/ML 22100020101805 $0.00000
DEXAMETHASONE ELIXIR 0.5 MG/5ML 22100020001005 $0.00000
DEXAMETHASONE SODIUM PHOSPHATE INJ 10 MG/ML 22100020202010 $0.60000
DEXAMETHASONE SODIUM PHOSPHATE OPHTH OINT 0.05% 86300010104205 $0.00000
DEXAMETHASONE SODIUM PHOSPHATE OPHTH SOLN 0.1% 86300010102005 $2.30000
DEXAMETHASONE TAB 0.5 MG 22100020000315 $0.09820
DEXAMETHASONE TAB 0.75 MG 22100020000320 $0.17180
DEXAMETHASONE TAB 0.75 MG DOSE PACK 22100020006400 $0.00000
DEXAMETHASONE TAB 1.5 MG 22100020000330 $0.20000
DEXAMETHASONE TAB 4 MG 22100020000340 $0.25000
DEXAMETHASONE TAB 6 MG 22100020000345 $0.50000
DEXCHLORPHENIRAMINE MALEATE SYRUP 2 MG/5ML 41100030151205 $0.00000
DEXCHLORPHENIRAMINE MALEATE TAB CR 6 MG 41100030150410 $0.00000
DEXMETHYLPHENIDATE HCL TAB 10 MG 61400016100340 $0.94960
DEXMETHYLPHENIDATE HCL TAB 2.5 MG 61400016100320 $0.48430
DEXMETHYLPHENIDATE HCL TAB 5 MG 61400016100330 $0.69850
DEXTROAMPHETAMINE SULFATE CAP CR 10 MG 61100020100210 $0.89770
DEXTROAMPHETAMINE SULFATE CAP CR 15 MG 61100020100215 $0.00000
DEXTROAMPHETAMINE SULFATE CAP CR 5 MG 61100020100205 $0.00000
DEXTROAMPHETAMINE SULFATE CAP SR 24HR 10 MG 61100020107010 $1.72690
DEXTROAMPHETAMINE SULFATE CAP SR 24HR 15 MG 61100020107015 $2.19910
DEXTROAMPHETAMINE SULFATE CAP SR 24HR 5 MG 61100020107005 $1.51180
DEXTROAMPHETAMINE SULFATE TAB 5 MG 61100020100305 $0.19000
DEXTROMETHORPHAN-GG TAB SR 12HR 30-600MG 43997002527430 $0.00000
DEXTROMETHORPHAN-GUAIFENESIN LIQUID 10-100 MG/5ML 43997002520910 $0.02000
DEXTROMETHORPHAN-GUAIFENESIN SYRUP 10-100 MG/5ML 43997002521220 $0.02300
DEXTROSE 5% IN LACTATED RINGERS 79993002302020 $0.01000
DEXTROSE 5% W/ SODIUM CHLORIDE 0.2% 79993002202020 $0.00900
DEXTROSE 5% W/ SODIUM CHLORIDE 0.33% 79993002202025 $0.00800
DEXTROSE 5% W/ SODIUM CHLORIDE 0.45% 79993002202030 $0.00400
DEXTROSE 5% W/ SODIUM CHLORIDE 0.9% 79993002202035 $0.01000
DEXTROSE INJ 10% 80100020002020 $0.01000
DEXTROSE INJ 20% 80100020002025 $0.01900
DEXTROSE INJ 5% 80100020002015 $0.02500
DEXTROSE INJ 50% 80100020002050 $0.02300
DIAZEPAM INJ 5 MG/ML 57100040002010 $0.00000
DIAZEPAM TAB 10 MG 57100040000315 $0.07000
DIAZEPAM TAB 2 MG 57100040000305 $0.04300
DIAZEPAM TAB 5 MG 57100040000310 $0.04500
DICLOFENAC POTASSIUM TAB 50 MG 66100007100330 $0.38500
DICLOFENAC SODIUM EC TAB 25 MG 66100007000610 $0.00000
DICLOFENAC SODIUM EC TAB 50 MG 66100007000620 $0.00000
DICLOFENAC SODIUM EC TAB 75 MG 66100007000630 $0.00000
DICLOFENAC SODIUM OPHTH SOLN 0.1% 86805010102010 $5.57000
DICLOFENAC SODIUM TAB DELAYED RELEASE 25 MG 66100007200610 $0.00000
DICLOFENAC SODIUM TAB DELAYED RELEASE 50 MG 66100007200620 $0.41530
DICLOFENAC SODIUM TAB DELAYED RELEASE 75 MG 66100007200630 $0.49500
DICLOFENAC SODIUM TAB SR 24HR 100 MG 66100007207530 $1.37980
DICLOFENAC SODIUM TAB SR 24HR 100 MG 66100007007530 $0.00000
DICLOXACILLIN SODIUM CAP 250 MG 01300020100110 $0.30500
DICLOXACILLIN SODIUM CAP 500 MG 01300020100115 $0.59500
DICYCLOMINE HCL CAP 10 MG 49103010100105 $0.09500
DICYCLOMINE HCL TAB 20 MG 49103010100305 $0.10000
DIDANOSINE DELAYED RELEASE CAPSULE 200 MG 12105015006528 $4.86500
DIDANOSINE DELAYED RELEASE CAPSULE 250 MG 12105015006535 $5.76500
DIDANOSINE DELAYED RELEASE CAPSULE 400 MG 12105015006550 $8.83000
DIETHYLPROPION HCL TAB 25 MG 61200020100305 $0.23380
DIETHYLPROPION HCL TAB CR 75 MG 61200020100405 $0.00000
DIETHYLPROPION HCL TAB SR 24HR 75 MG 61200020107510 $0.00000
DIFLORASONE DIACETATE CREAM 0.05% 90550050103705 $1.18000
DIFLORASONE DIACETATE OINT 0.05% 90550050104205 $0.99000
DIFLUNISAL TAB 250 MG 64100050000305 $0.00000
DIFLUNISAL TAB 500 MG 64100050000310 $0.00000
DIGOXIN ELIXIR 0.05 MG/ML 31200010001005 $0.00000
DIGOXIN TAB 0.125 MG 31200010000305 $0.00000
DIGOXIN TAB 0.25 MG 31200010000310 $0.00000
DIHYDROERGOTAMINE MESYLATE INJ 1 MG/ML 67000030102005 $0.00000
DILTIAZEM HCL CAP CR 120 MG/24HR 34000010100260 $0.00000
DILTIAZEM HCL CAP SR 12HR 120 MG 34000010106920 $0.86500
DILTIAZEM HCL CAP SR 12HR 60 MG 34000010106910 $0.45000
DILTIAZEM HCL CAP SR 12HR 90 MG 34000010106915 $0.62000
DILTIAZEM HCL CAP SR 24HR 120 MG 34000010107020 $0.52000
DILTIAZEM HCL CAP SR 24HR 180 MG 34000010107030 $0.52180
DILTIAZEM HCL CAP SR 24HR 240 MG 34000010107040 $0.54280
DILTIAZEM HCL COATED BEADS CAP SR 24HR 120 MG 34000010127020 $0.54530
DILTIAZEM HCL COATED BEADS CAP SR 24HR 180 MG 34000010127030 $0.67290
DILTIAZEM HCL COATED BEADS CAP SR 24HR 240 MG 34000010127040 $0.88910
DILTIAZEM HCL COATED BEADS CAP SR 24HR 300 MG 34000010127050 $1.10470
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 120 34000010117020 $0.50000
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 180 34000010117030 $0.97000
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 240 34000010117040 $1.38000
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 300 34000010117050 $1.78000
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 360 34000010117060 $1.67280
DILTIAZEM HCL EXTENDED RELEASE BEADS CAP SR 24HR 420 34000010117070 $1.66150
DILTIAZEM HCL TAB 120 MG 34000010100320 $0.20000
DILTIAZEM HCL TAB 30 MG 34000010100305 $0.07000
DILTIAZEM HCL TAB 60 MG 34000010100310 $0.10000
DILTIAZEM HCL TAB 90 MG 34000010100315 $0.14000
DIPHENHYDRAMINE (SLEEP) CAP 50 MG 60300020100110 $0.13200
DIPHENHYDRAMINE HCL (SLEEP) TAB 25 MG 60300020100305 $0.10900
DIPHENHYDRAMINE HCL CAP 25 MG 41200030100105 $0.08500
DIPHENHYDRAMINE HCL CAP 50 MG 41200030100110 $0.03800
DIPHENHYDRAMINE HCL ELIXIR 12.5 MG/5ML 41200030101010 $0.00000
DIPHENHYDRAMINE HCL INJ 10 MG/ML 41200030102005 $0.00000
DIPHENHYDRAMINE HCL LIQUID 12.5 MG/5ML 41200030100920 $0.02100
DIPHENHYDRAMINE HCL TAB 25 MG 41200030100305 $0.09300
DIPHENHYDRAMINE TAN-PHENYLEPHRINE TAN CHEW TAB 25-10 MG 43993002570520 $0.00000
DIPHENOXYLATE W/ ATROPINE LIQ 2.5 MG/5ML 47100010100910 $0.00000
DIPHENOXYLATE W/ ATROPINE TAB 2.5 MG 47100010100310 $0.14000
DIPIVEFRIN HCL OPHTH SOLN 0.1% 86600010002005 $0.00000
DIPIVEFRIN HCL OPHTH SOLN 0.1% 86600010002005 $0.85000
DIPIVEFRIN HCL OPHTH SOLN 0.1% 86600010002005 $0.82000
DIPIVEFRIN HCL OPHTH SOLN 0.1% 86600010002005 $0.87000
DIPYRIDAMOLE TAB 25MG 85150030000310 $0.22000
DIPYRIDAMOLE TAB 50MG 85150030000320 $0.35000
DIPYRIDAMOLE TAB 75MG 85150030000330 $0.46000
DISOPYRAMIDE PHOSPHATE CAP 100 MG 35100010100105 $0.35000
DISOPYRAMIDE PHOSPHATE CAP 150 MG 35100010100110 $0.48000
DISOPYRAMIDE PHOSPHATE CAP CR 100 MG 35100010100205 $0.00000
DISOPYRAMIDE PHOSPHATE CAP SR 12HR 150 MG 35100010106915 $0.00000
DIVALPROEX SODIUM CAP SPRINKLE 125 MG 72500010106820 $0.55530
DIVALPROEX SODIUM TAB DELAYED RELEASE 125 MG 72500010100605 $0.16000
DIVALPROEX SODIUM TAB DELAYED RELEASE 250 MG 72500010100610 $0.22950
DIVALPROEX SODIUM TAB DELAYED RELEASE 500 MG 72500010100615 $0.40620
DIVALPROEX SODIUM TAB SR 24 HR 250 MG 72500010107520 $0.80430
DIVALPROEX SODIUM TAB SR 24 HR 500 MG 72500010107530 $1.24460
DOBUTAMINE HCL INJ 12.5 MG/ML 38000010102005 $0.00000
DOBUTAMINE INJ 0.5 MG/ML IN D5W 38000010112005 $0.00000
DOBUTAMINE INJ 1 MG/ML IN D5W 38000010112010 $0.00000
DOBUTAMINE INJ 2 MG/ML IN D5W 38000010112020 $0.00000
DOBUTAMINE INJ 4 MG/ML IN D5W 38000010112040 $0.00000
DOCUSATE SODIUM CAP 100 MG 46500010300110 $0.03000
DOCUSATE SODIUM LIQUID 150 MG/15ML 46500010300910 $0.00000
DOPAMINE HCL INJ 160 MG/ML 38000020102040 $0.00000
DOPAMINE HCL INJ 40 MG/ML 38000020102010 $0.00000
DOPAMINE HCL INJ 80 MG/ML 38000020102020 $0.00000
DOPAMINE INJ 0.8 MG/ML IN D5W 38000020112010 $0.00000
DOPAMINE INJ 1.6 MG/ML IN D5W 38000020112020 $0.00000
DOPAMINE INJ 3.2 MG/ML IN D5W 38000020112030 $0.00000
DORZOLAMIDE HCL OPHTH SOLN 2% 86802340102020 $4.66000
DORZOLAMIDE-TIMOLOL OPHTH SOLN 2-0.5% (BASE EQUIV) 86259902202020 $7.70680
DOXAZOSIN MESYLATE TAB 1 MG 36202005100310 $0.20430
DOXAZOSIN MESYLATE TAB 2 MG 36202005100320 $0.14500
DOXAZOSIN MESYLATE TAB 4 MG 36202005100330 $0.23500
DOXAZOSIN MESYLATE TAB 8 MG 36202005100340 $0.21000
DOXEPIN HCL CAP 10 MG 58200040100105 $0.06000
DOXEPIN HCL CAP 100 MG 58200040100125 $0.23500
DOXEPIN HCL CAP 150 MG 58200040100130 $0.32500
DOXEPIN HCL CAP 25 MG 58200040100110 $0.08000
DOXEPIN HCL CAP 50 MG 58200040100115 $0.14500
DOXEPIN HCL CAP 75 MG 58200040100120 $0.18000
DOXEPIN HCL CONC 10 MG/ML 58200040101305 $0.07500
DOXEPIN HCL CREAM 5% 90220015103710 $0.00000
DOXORUBICIN HCL FOR INJ 10 MG 21200040102105 $30.00000
DOXORUBICIN HCL FOR INJ 20 MG 21200040102110 $0.00000
DOXORUBICIN HCL FOR INJ 50 MG 21200040102115 $139.50000
DOXORUBICIN HCL INJ 2 MG/ML 21200040102010 $2.20000
DOXYCYCLINE HYCLATE CAP 100 MG 04000020100110 $0.10000
DOXYCYCLINE HYCLATE CAP 50 MG 04000020100105 $0.09500
DOXYCYCLINE HYCLATE FOR INJ 100 MG 04000020102105 $0.00000
DOXYCYCLINE HYCLATE TAB 100 MG 04000020100310 $0.10000
DOXYCYCLINE HYCLATE TAB 20 MG 04000020100302 $0.96700
DOXYCYCLINE MONOHYDRATE CAP 100 MG 04000020000110 $0.67100
DOXYCYCLINE MONOHYDRATE CAP 50 MG 04000020000105 $0.71500
DOXYCYCLINE MONOHYDRATE TAB 100 MG 04000020000310 $2.22000
DOXYCYCLINE MONOHYDRATE TAB 150 MG 04000020000315 $6.00000
DOXYCYCLINE MONOHYDRATE TAB 50 MG 04000020000305 $1.75500
DOXYCYCLINE MONOHYDRATE TAB 75 MG 04000020000307 $2.53000
DRONABINOL CAP 10 MG 50300030000120 $16.70630
DRONABINOL CAP 2.5 MG 50300030000110 $4.01500
DRONABINOL CAP 5 MG 50300030000115 $8.35000
DROPERIDOL INJ 2.5 MG/ML 57200030002005 $0.00000
DROSPIRENONE-ETHINYL ESTRADIOL TAB 3-0.03 MG 25990002150320 $0.00000

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