Acid reducers (PPIs and Voquezna) on every 2026 Wisconsin Part D plan
Pick a drug class, or type the drugs you want to check, and see which of the 10 stand-alone Part D plans in Wisconsin cover each one, on what tier, and with what restrictions.
- Covered
- Covered, needs prior authorization (PA) or step therapy (ST)
- Not on the formulary
- QL 60/30d = quantity limit, 60 units per 30 days
| Drug | Wellcare Classic$0.00/moS4802-097 | Wellcare Value Script$0.00/moS4802-132 | HealthSpring Assurance Rx$0.00/moS5617-223 | Humana Basic Rx Plan$0.00/moS5884-139 | Humana Value Rx Plan$0.00/moS5884-195 | AARP Medicare Rx Saver from UHC$0.00/moS5921-361 | SilverScript Choice$26.70/moS5601-032 | HealthSpring Extra Rx$56.30/moS5617-366 | Humana Premier Rx Plan$110.60/moS5884-162 | AARP Medicare Rx Preferred from UHC$113.90/moS5921-397 |
|---|---|---|---|---|---|---|---|---|---|---|
| omeprazolegeneric Prilosec | Tier 2$10.00QL 60/30d | Tier 1$0.00QL 60/30d | Tier 210%QL 60/30d | Tier 2$1.00 | Tier 1$0.00 | Tier 2$7.00 | Tier 1$2.00QL 30/30d | Tier 1$0.00QL 60/30d | Tier 1$0.00 | Tier 1$5.00 |
| pantoprazolegeneric Protonix | Tier 2$10.00QL 60/30d | Tier 1$0.00QL 60/30d | Tier 210%QL 60/30d | Tier 2$1.00QL 60/30d | Tier 2$0.00QL 60/30d | Tier 2$7.00QL 90/30d | Tier 1$2.00QL 30/30d | Tier 1$0.00QL 60/30d | Tier 1$0.00QL 60/30d | Tier 1$5.00QL 90/30d |
| esomeprazolegeneric Nexium | Tier 426%QL 60/30d | Tier 440%QL 60/30d | Not covered | Not covered | Tier 320%QL 60/30d | Not covered | Tier 2$10.00QL 30/30d | Tier 317%QL 60/30d | Tier 3$45.00QL 60/30d | Tier 315%QL 90/30d |
| lansoprazolegeneric Prevacid | Tier 325%QL 60/30d | Tier 2$3.00QL 60/30d | Not covered | Not covered | Not covered | Not covered | Tier 2$10.00QL 30/30d | Tier 317%QL 60/30d | Tier 3$45.00QL 60/30d | Tier 2$10.00QL 60/30d |
| rabeprazolegeneric Aciphex | Not covered | Tier 2$3.00QL 60/30d | Not covered | Not covered | Not covered | Not covered | Tier 435%QL 30/30d | Not covered | Not covered | Tier 315% |
| dexlansoprazolegeneric Dexilant | Not covered | Tier 440%QL 30/30d | Not covered | Not covered | Not covered | Not covered | Tier 435%QL 30/30d | Tier 4ST33%QL 30/30d | Not covered | Tier 436%QL 30/30d |
| famotidinegeneric Pepcid (H2 blocker) | Tier 2$10.00 | Tier 1$0.00 | Tier 325% | Tier 2$1.00 | Tier 2$0.00 | Tier 2$7.00 | Tier 1$2.00 | Tier 1$0.00 | Tier 2$4.00 | Tier 1$5.00 |
| Voqueznavonoprazan | Not covered | Not covered | Not covered | Not covered | Not covered | Tier 4PA33% | Tier 4PA35%QL 224/365d | Not covered | Not covered | Tier 4PA36% |
Where a plan covers several strengths or forms of a drug, the cell shows the least restricted one. Costs are the 30-day preferred-pharmacy cost-sharing in the initial coverage phase, from the CMS 2026 formulary files. Click a plan for its full drug list.