2009 Medicare Part D Plan Formulary Information |
Blue MedicareRx Premier (S5596-023-0)
Sanctioned Plan
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The Blue MedicareRx Premier (S5596-023-0) Formulary Drugs Starting with the Letter B in CMS PDP Region 16 which includes: WI
|
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACIIM POWDER FOR INJECTION SOLUTION 50000UNT/VIAL ![Compare how all Medicare Part D PDP plans in WI cover BACIIM POWDER FOR INJECTION SOLUTION 50000UNT/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BACITRACIN 500U/GM EYE OINT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN 500U/GM EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BACLOFEN 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BACTRIM 400-80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM 400-80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BACTRIM DS TABLET 800-160 ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM DS TABLET 800-160.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BACTROBAN 2% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BACTROBAN 2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BALACET 325 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALACET 325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:360 /30Days |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in WI cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BALZIVA 0.4-0.035 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALZIVA 0.4-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:28 /28Days |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in WI cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BANZEL TABLET ![Compare how all Medicare Part D PDP plans in WI cover BANZEL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BARACLUDE 0.05MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.05MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BD INSULIN SYRINGE ULT-FINE II ![Compare how all Medicare Part D PDP plans in WI cover BD INSULIN SYRINGE ULT-FINE II.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:200 /30Days |
BD INSULIN SYRINGE ULT-FINE II ![Compare how all Medicare Part D PDP plans in WI cover BD INSULIN SYRINGE ULT-FINE II.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:200 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BD INSULIN SYRINGE ULTRA-FINE SYRING ![Compare how all Medicare Part D PDP plans in WI cover BD INSULIN SYRINGE ULTRA-FINE SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:200 /30Days |
BD ORGINAL PEN NEEDLES 29G ![Compare how all Medicare Part D PDP plans in WI cover BD ORGINAL PEN NEEDLES 29G.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:200 /30Days |
BECONASE AQ 0.042% SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BECONASE AQ 0.042% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:50 /30Days |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENICAR 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENICAR 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENICAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENICAR HCT 20-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 20-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENICAR HCT 40-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 40-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENICAR HCT TABLET 12.5-40MG (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT TABLET 12.5-40MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENOQUIN 20% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BENOQUIN 20% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENTYL 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BENTYL 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENTYL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover BENTYL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENTYL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENTYL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BENTYL INJECTION 20MG/2ML AMP ![Compare how all Medicare Part D PDP plans in WI cover BENTYL INJECTION 20MG/2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENZACLIN GEL 1-5% ![Compare how all Medicare Part D PDP plans in WI cover BENZACLIN GEL 1-5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:50 /30Days |
BENZAMYCIN GEL ![Compare how all Medicare Part D PDP plans in WI cover BENZAMYCIN GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:47 /30Days |
BENZTROPINE MES 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENZTROPINE MES TABLET 1MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES TABLET 1MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BENZTROPINE MES TABLET 2MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES TABLET 2MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETA-VAL 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETA-VAL 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETA-VAL 0.1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETA-VAL 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAGAN 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETAGAN 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BETAGAN 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETAGAN 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BETAMETHASONE DIPROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DIPROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DIPROPIONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DIPROPIONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE DIPROPIONATE 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DIPROPIONATE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DIPROPIONATE 0.05% OINT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DIPROPIONATE 0.05% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DIPROPIONATE LOTION 60ML ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DIPROPIONATE LOTION 60ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DP 0.05% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE DP 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE VA 0.1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAMETHASONE VA 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAPACE 120MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETAPACE 160MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAPACE 240MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE 240MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETAPACE 80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETAPACE AF 120MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETAPACE AF 160MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETAPACE AF 80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BETASERON 0.3MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BETASERON 0.3MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | P |
BETAXOLOL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAXOLOL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETAXOLOL HCL 0.5% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL HCL 0.5% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:30 /30Days |
BETHANECHOL CHLORIDE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETHANECHOL CHLORIDE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETHANECHOL CHLORIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BETIMOL 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BETOPTIC S 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETOPTIC S 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BIAXIN 125MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN 125MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:200 /1Days |
BIAXIN 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:42 /1Days |
BIAXIN 250MG/5ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN 250MG/5ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:100 /1Days |
BIAXIN 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:28 /1Days |
BIAXIN XL 500MG TABLET 56 BOX ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN XL 500MG TABLET 56 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:28 /1Days |
BIAXIN XL 500MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover BIAXIN XL 500MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:28 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in WI cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BICNU 100MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BICNU 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BIDIL TABLET 20MG/37.5MG ![Compare how all Medicare Part D PDP plans in WI cover BIDIL TABLET 20MG/37.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | None |
BILTRICIDE 600MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BILTRICIDE 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BLENOXANE 15 UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover BLENOXANE 15 UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BLEOMYCIN FOR INJECTION USP 15UNITS 1 X 10ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover BLEOMYCIN FOR INJECTION USP 15UNITS 1 X 10ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in WI cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:30 /30Days |
BLEPHAMIDE 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:20 /30Days |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:20 /30Days |
BONIVA 150MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:1 /28Days |
BONIVA 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:30 /30Days |
BONIVA 3MG/3ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 3MG/3ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BOOSTRIX INJECTION SUSPENSION 2.5UNT-5ML 5 X .5ML SYR ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX INJECTION SUSPENSION 2.5UNT-5ML 5 X .5ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | None |
BOROFAIR SOL 2% OTIC ![Compare how all Medicare Part D PDP plans in WI cover BOROFAIR SOL 2% OTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BOTOX 100UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOTOX 100UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | P |
BRETHINE 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BRETHINE 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BRETHINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRETHINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BRETHINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRETHINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BREVICON TABLET 0.5/35 ![Compare how all Medicare Part D PDP plans in WI cover BREVICON TABLET 0.5/35.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | Q:28 /28Days |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BROMOCRIPTINE MESYLATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE MESYLATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUDEPRION SR 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover BUDEPRION SR 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUDEPRION SR 150MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover BUDEPRION SR 150MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
BUDEPRION XL 300MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover BUDEPRION XL 300MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:30 /30Days |
BUDEPRION XL TABLETS 150MG 500 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover BUDEPRION XL TABLETS 150MG 500 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:90 /30Days |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BUMETANIDE 0.5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUMETANIDE 1MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 1MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUMETANIDE 2MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 2MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUMEX 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMEX 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUMEX 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMEX 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUMEX 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMEX 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUPHENYL 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5. |
33% | N/A | None |
BUPRENEX 0.3MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover BUPRENEX 0.3MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BUPROBAN ER TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROBAN ER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
BUPROPION HCL 100MG ER TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 100MG ER TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
BUPROPION HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:120 /30Days |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
BUPROPION HCL TABLET 100MG ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL TABLET 100MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:120 /30Days |
BUPROPION HCL TABLET SUSTAINED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL TABLET SUSTAINED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:60 /30Days |
BUSPAR 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPAR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUSPAR 15MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPAR 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUSPAR 30MG DIVIDOSE TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPAR 30MG DIVIDOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUSPAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred Brand or Generic |
$75.00 | $187.50 | None |
BUSPIRONE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUSPIRONE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUSULFEX 6MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover BUSULFEX 6MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BUTALBITAL ASPIRIN CAFFEINE CODEINE PHOSPHATE 325-50-40MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL ASPIRIN CAFFEINE CODEINE PHOSPHATE 325-50-40MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
BUTALBITAL/CAFF/APAP/COD CP ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/CAFF/APAP/COD CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | Q:180 /30Days |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$9.00 | $13.50 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL TARTRATE INJECTION 1MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL TARTRATE INJECTION 2MG 10 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Non-Specialty Injectable |
33% | 33% | None |
BYETTA 10MCG/0.04ML PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 10MCG/0.04ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:3 /30Days |
BYETTA 5MCG/0.02ML PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 5MCG/0.02ML PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$35.00 | $87.50 | Q:3 /30Days |