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You will instantly receive a list of the Medicare Part D plans that fulfill your requirements.
Please note: The plan’s average retail drug price (30-day supply) shown below is from the dataset. Your actual retail drug price may differ significantly from the average shown. Please contact the Medicare plan or Medicare (1-800-Medicare) for more specific pricing based on your chosen pharmacy.
There are 74 Medicare Advantage plans (MAPD) in WINNEBAGO County, Wisconsin meeting your criteria.
Caution: The 2010 Medicare Advantage plan information below is for research purposes.
Click here to see 2024 Medicare Advantage plans
DECLOMYCIN 150MG TABLET (NDC: 14168286501)
2010 Medicare Prescription Drug Plan (MAPD) Information
Click here for the Chart Legend |
Plan Name |
Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Plan’s Avg. Retail Drug Price 30-Day |
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Mail Order |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Anthem Medicare Preferred Standard (PPO)
|
$0.00 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Network PlatinumSelect (PPO)
|
$0.00 |
$0 | to be determined | 4 |
Tier 4 |
$53.00 | $150.00 | None | $1,086.03 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
|
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$4.50 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.30 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,090.82 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
SmartValue Plus (PFFS)
|
$5.70 |
$0 | to be determined | 3 |
Tier 3 |
$85.00 | $212.50 | Q:84 /1Days | $1,347.99 |
Browse Plan Formulary |
Plan Name |
Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Retail Drug Price |
Network PlatinumPlus Pharmacy (PPO)
|
$27.90 |
$0 | to be determined | 4 |
Tier 4 |
$53.00 | $150.00 | None | $1,086.03 |
Browse Plan Formulary |
Network Cares (PPO)
|
$38.20 |
$0 | to be determined | 4 |
Tier 4 |
$94.00 | $282.00 | None | $1,086.03 |
Browse Plan Formulary |
Network PlatinumPremier Pharmacy (PPO)
|
$42.20 |
$0 | to be determined | 4 |
Tier 4 |
$53.00 | $150.00 | None | $1,086.03 |
Browse Plan Formulary |