Thyroid hormone 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 |
|---|---|---|---|---|---|---|---|---|---|---|
| levothyroxinegeneric Synthroid | Tier 2$10.00 | Tier 1$0.00 | Tier 210% | Tier 1$0.00 | Tier 1$0.00 | Tier 1$2.00 | Tier 1$2.00 | Tier 1$0.00 | Tier 1$0.00 | Tier 1$5.00 |
| Synthroidlevothyroxine | Tier 426% | Tier 440% | Tier 430% | Tier 325% | Tier 320% | Tier 317% | Tier 435% | Tier 433% | Tier 3$45.00 | Tier 315% |
| Levoxyllevothyroxine | Not covered | Tier 1$0.00 | Tier 325% | Tier 432% | Tier 435% | Tier 317% | Tier 1$2.00 | Tier 317% | Tier 450% | Tier 315% |
| Unithroidlevothyroxine | Not covered | Tier 1$0.00 | Tier 430% | Not covered | Not covered | Tier 317% | Tier 1$2.00 | Tier 317% | Not covered | Tier 315% |
| liothyroninegeneric Cytomel | Tier 325% | Tier 2$3.00 | Tier 325% | Tier 325% | Tier 320% | Tier 317% | Tier 2$10.00 | Tier 317% | Tier 3$45.00 | Tier 2$10.00 |
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.