2011 Medicare Part D Plan Formulary Information |
Advocare Essence Rx (HMO-POS) (H5211-002-0)
Benefit Details
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The Advocare Essence Rx (HMO-POS) (H5211-002-0) Formulary Drugs Starting with the Letter F in Douglas County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter F
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
FABRAZYME 35MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover FABRAZYME 35MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FACTIVE 320MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FACTIVE 320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FAMCICLOVIR 125MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMCICLOVIR 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMCICLOVIR 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMOTIDINE 20MG PIGGYBACK ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE 20MG PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMOTIDINE 20MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE 20MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMOTIDINE 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMOTIDINE FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FAMVIR 125MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMVIR 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FAMVIR 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMVIR 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FAMVIR 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMVIR 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FARESTON 60MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FARESTON 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FASLODEX INJECTION ![Compare how all Medicare Part D PDP plans in WI cover FASLODEX INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FAZACLO TABLETS ORALLY DISINTEGRATING ![Compare how all Medicare Part D PDP plans in WI cover FAZACLO TABLETS ORALLY DISINTEGRATING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FELBATOL 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FELBATOL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FELBATOL 600MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FELBATOL 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FELBATOL 600MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover FELBATOL 600MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FELDENE 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FELDENE 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FELDENE 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FELDENE 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FELODIPINE ER 2.5MG TABLET 90 TABLET BOT ![Compare how all Medicare Part D PDP plans in WI cover FELODIPINE ER 2.5MG TABLET 90 TABLET BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FELODIPINE TABLET ER 10MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover FELODIPINE TABLET ER 10MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FELODIPINE TABLET ER 5MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover FELODIPINE TABLET ER 5MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FEMARA 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMARA 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FEMHRT 0.5MG/2.5MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMHRT 0.5MG/2.5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FEMHRT 1/5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMHRT 1/5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FEMTRACE 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMTRACE 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FEMTRACE 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMTRACE 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FEMTRACE 1.8MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEMTRACE 1.8MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FENOFIBRATE 134MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 134MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENOFIBRATE 160MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENOFIBRATE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENOFIBRATE 54MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 54MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENOFIBRATE 67MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 67MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENOPROFEN 600MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FENOPROFEN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENTANYL 0.025 MG/HR TRANSDERMAL PATCH 72 HR [DURAGESIC] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 0.025 MG/HR TRANSDERMAL PATCH 72 HR [DURAGESIC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 100MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 12MCG/HR PATCH TRANSDERMAL 72 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FENTANYL CITRATE LOZENGES ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE LOZENGES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENTANYL CITRATE OTFC 200 MCG ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE OTFC 200 MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL TRANSDERMAL SYSTEM 25MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL TRANSDERMAL SYSTEM 50MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FENTANYL TRANSDERMAL SYSTEM 75MCG 5 SYSTEMS CRTN ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL TRANSDERMAL SYSTEM 75MCG 5 SYSTEMS CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FEXOFENADINE HCL 180MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEXOFENADINE HCL 180MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | S Q:30 /30Days |
FEXOFENADINE HCL 30MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FEXOFENADINE HCL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | S Q:60 /30Days |
FEXOFENADINE HCL 60MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FEXOFENADINE HCL 60MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | S Q:60 /30Days |
FINASTERIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FINASTERIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FIORICET W/CODEINE CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FIORICET W/CODEINE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FIORINAL W/CODEINE #3 CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FIORINAL W/CODEINE #3 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLAGYL 250MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLAGYL 250MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLAGYL 375 CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FLAGYL 375 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLAGYL 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLAGYL 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLAGYL ER 750MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover FLAGYL ER 750MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLAREX 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover FLAREX 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLECAINIDE ACETATE 100 MG TAB #60 EA ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 100 MG TAB #60 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLECAINIDE ACETATE 150 MG TAB 360 EA ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 150 MG TAB 360 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLECAINIDE ACETATE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLECTOR PATCH ![Compare how all Medicare Part D PDP plans in WI cover FLECTOR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLEXERIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLEXERIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLEXERIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLEXERIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLOMAX 0.4MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover FLOMAX 0.4MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLONASE 0.05% NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover FLONASE 0.05% NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLOVENT DISKUS /BLIST AEPB ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS /BLIST AEPB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLOVENT DISKUS /BLIST AEPB ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS /BLIST AEPB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLOVENT DISKUS POWDER 50MCG 60 CTR ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS POWDER 50MCG 60 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLOVENT HFA 110MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 110MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLOVENT HFA 220MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 220MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLOVENT HFA 44MCG INHALATION AEROSOL ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 44MCG INHALATION AEROSOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLUCONAZOLE 200MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 200MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUCONAZOLE 50MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 50MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUCONAZOLE INJECTION 200MG 6 X 200/250ML CTR ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE INJECTION 200MG 6 X 200/250ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUCONAZOLE ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUCONAZOLE ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUCONAZOLE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUCONAZOLE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUDROCORTISONE ACETATE 0.1MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUMADINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUMADINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL ![Compare how all Medicare Part D PDP plans in WI cover FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINOLONE 0.01% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.01% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINOLONE 0.01% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.01% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINOLONE 0.025% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.025% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINOLONE 0.025% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.025% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINONIDE 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUOCINONIDE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINONIDE 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOCINONIDE EMOLLIENT 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE EMOLLIENT 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOROMETHOLONE 0.1% DROPS ![Compare how all Medicare Part D PDP plans in WI cover FLUOROMETHOLONE 0.1% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOROPLEX 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOROPLEX 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLUOROURACIL 2% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 2% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOROURACIL 5% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 5% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOROURACIL CREA 5% ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL CREA 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXETINE 20 MG ORAL CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE 20 MG ORAL CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXETINE 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXETINE 40MG CAPSULE (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE 40MG CAPSULE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUOXETINE CAPSULES 10MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE CAPSULES 10MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXETINE HCL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE HCL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXETINE HYDROCHLORIDE TABLETS 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE HYDROCHLORIDE TABLETS 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUOXYMESTERONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUOXYMESTERONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FLUPHENAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE 2.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 2.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE 5MG/ML CONC ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 5MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUPHENAZINE DECANOATE INJECTION USP 25MG 1 X 5ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE DECANOATE INJECTION USP 25MG 1 X 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUPHENAZINE HCL 2.5MG/5ML ELIXIR ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE HCL 2.5MG/5ML ELIXIR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLURBIPROFEN 0.03% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover FLURBIPROFEN 0.03% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLURBIPROFEN 100MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLURBIPROFEN 100MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLURBIPROFEN 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLURBIPROFEN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUTAMIDE 125MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FLUTAMIDE 125MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUTICASONE PROPIONATE 0.005% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover FLUTICASONE PROPIONATE 0.005% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUTICASONE PROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUTICASONE PROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover FLUTICASONE PROPIONATE 50MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUVOXAMINE MALEATE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUVOXAMINE MALEATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FLUVOXAMINE MALEATE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FML FORTE 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover FML FORTE 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FML LIQUIFILM 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover FML LIQUIFILM 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FML S.O.P. 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover FML S.O.P. 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FOCALIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FOCALIN 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FOCALIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FOCALIN XR 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN XR 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FOCALIN XR 15MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN XR 15MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FOCALIN XR 20MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN XR 20MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FOCALIN XR 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN XR 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FOCALIN XR CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover FOCALIN XR CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FORADIL AEROLIZER 12 MCG CAP ![Compare how all Medicare Part D PDP plans in WI cover FORADIL AEROLIZER 12 MCG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTAZ 1GM ADD-VANTAGE VIAL ![Compare how all Medicare Part D PDP plans in WI cover FORTAZ 1GM ADD-VANTAGE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTAZ 2GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover FORTAZ 2GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTAZ 6GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover FORTAZ 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTAZ/ISO-OSMOT 2GM/50ML ![Compare how all Medicare Part D PDP plans in WI cover FORTAZ/ISO-OSMOT 2GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTAZ/ISO-OSMOTIC 1GM/50ML ![Compare how all Medicare Part D PDP plans in WI cover FORTAZ/ISO-OSMOTIC 1GM/50ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FORTEO INJECTION ![Compare how all Medicare Part D PDP plans in WI cover FORTEO INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P Q:2 /30Days |
FORTICAL 200 U/DOSE AEROSOL SPRAY W/PUMP ![Compare how all Medicare Part D PDP plans in WI cover FORTICAL 200 U/DOSE AEROSOL SPRAY W/PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FOSAMAX 10MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX 10MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:30 /30Days |
FOSAMAX 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:30 /30Days |
FOSAMAX 5MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX 5MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FOSAMAX 70MG ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX 70MG ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:300 /28Days |
FOSAMAX 70MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:4 /28Days |
FOSAMAX PLUS D 70MG-5600 TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX PLUS D 70MG-5600 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:4 /28Days |
FOSAMAX PLUS D 70MG/2800 IU ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX PLUS D 70MG/2800 IU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:4 /28Days |
FOSAMAX TABLET 35MG 20 BLPK ![Compare how all Medicare Part D PDP plans in WI cover FOSAMAX TABLET 35MG 20 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:4 /28Days |
FOSCARNET 24MG/ML INFUS BTTL ![Compare how all Medicare Part D PDP plans in WI cover FOSCARNET 24MG/ML INFUS BTTL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FOSINOPRIL SODIUM 10MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 10MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FOSINOPRIL SODIUM 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FOSINOPRIL SODIUM 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL-HYDROCHLOROTHIAZIDE 10-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL-HYDROCHLOROTHIAZIDE 20-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1 ![Compare how all Medicare Part D PDP plans in WI cover FRAGMIN 25000UNITS/ML VIAL 3.8ML x 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FRAGMIN 2500UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover FRAGMIN 2500UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FRAGMIN 5000UNITS SYRINGE 0.2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover FRAGMIN 5000UNITS SYRINGE 0.2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FRAGMIN INJECTION 10000UNITS 1 X 10 SYR ![Compare how all Medicare Part D PDP plans in WI cover FRAGMIN INJECTION 10000UNITS 1 X 10 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FRAGMIN INJECTION 7500UNT/ML ![Compare how all Medicare Part D PDP plans in WI cover FRAGMIN INJECTION 7500UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
FROVA 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FROVA 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | Q:12 /30Days |
FURADANTIN 25 MG/5 ML SUSP 230 ML ![Compare how all Medicare Part D PDP plans in WI cover FURADANTIN 25 MG/5 ML SUSP 230 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
FUROSEMIDE 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FUROSEMIDE 20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FUROSEMIDE 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FUROSEMIDE 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FUROSEMIDE 80MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 80MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FUROSEMIDE INJECTION USP 10MG 25 X 4ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE INJECTION USP 10MG 25 X 4ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
FUZEON CONVENIENCE KIT ![Compare how all Medicare Part D PDP plans in WI cover FUZEON CONVENIENCE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |