2012 Medicare Part D Plan Formulary Information |
Medica Prime Solution Value with Part D Option 3 (Cost) (H2450-028-0)
Benefit Details
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The Medica Prime Solution Value with Part D Option 3 (Cost) (H2450-028-0) Formulary Drugs Starting with the Letter I in BARRON County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE SODIUM 150 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE SODIUM 150 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | Q:1 /28Days |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IBUPROFEN 600mg/1 500 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 600mg/1 500 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IBUPROFEN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IBUPROFEN TABLETS ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IDAMYCIN PFS 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IDAMYCIN PFS 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
IDARUBICIN HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IDARUBICIN HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IFEX INJECTION 3GM/ML 3GM VIALSD ![Compare how all Medicare Part D PDP plans in WI cover IFEX INJECTION 3GM/ML 3GM VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | P |
IFOSFAMIDE FOR INFECTION 1 GM ![Compare how all Medicare Part D PDP plans in WI cover IFOSFAMIDE FOR INFECTION 1 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | P |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in WI cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/ ![Compare how all Medicare Part D PDP plans in WI cover IFOSFAMIDE/MESNA KIT 1G/20ML / 1MG/.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | P |
Ilaris 150mg/mL 1 VIAL, SINGLE-USE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in WI cover Ilaris 150mg/mL 1 VIAL, SINGLE-USE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
IMIPENEM-CILASTATIN 250 MG VL ![Compare how all Medicare Part D PDP plans in WI cover IMIPENEM-CILASTATIN 250 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPENEM-CILASTATIN 500 MG VL ![Compare how all Medicare Part D PDP plans in WI cover IMIPENEM-CILASTATIN 500 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IMIPRAMINE PAMOATE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMIQUIMOD 5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover IMIQUIMOD 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | P Q:24 /30Days |
IMITREX 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:9 /28Days |
IMITREX 20MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 20MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:12 /28Days |
IMITREX 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:9 /28Days |
IMITREX 4MG/0.5ML KIT REFILL ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 4MG/0.5ML KIT REFILL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:4 /28Days |
IMITREX 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:9 /28Days |
IMITREX 5MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 5MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:18 /28Days |
IMITREX 6MG/0.5ML SYRNG KIT ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 6MG/0.5ML SYRNG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:4 /28Days |
IMITREX 6MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 6MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:4 /28Days |
IMOVAX RABIES VACCINE 2.5UNT/ML ![Compare how all Medicare Part D PDP plans in WI cover IMOVAX RABIES VACCINE 2.5UNT/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | P |
IMURAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMURAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Incivek 375mg/1 4 BOX in 1 CARTON / 7 BLISTER PACK in 1 BOX / 6 TABLET, FILM COATED in 1 BLISTER PA ![Compare how all Medicare Part D PDP plans in WI cover Incivek 375mg/1 4 BOX in 1 CARTON / 7 BLISTER PACK in 1 BOX / 6 TABLET, FILM COATED in 1 BLISTER PA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P Q:168 /28Days |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE in 1 CARTON / 4 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Increlex 40mg/4mL 1 VIAL, MULTI-DOSE in 1 CARTON / 4 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
Indapamide 1.25mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Indapamide 1.25mg/1 100 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
INDAPAMIDE 2.5MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover INDAPAMIDE 2.5MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT ![Compare how all Medicare Part D PDP plans in WI cover INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
INDOMETHACIN 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
INDOMETHACIN 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDOMETHACIN CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
INFERGEN INJECTION ![Compare how all Medicare Part D PDP plans in WI cover INFERGEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
INFUMORPH 10MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in WI cover INFUMORPH 10MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INFUMORPH 25MG/ML AMPUL P/F ![Compare how all Medicare Part D PDP plans in WI cover INFUMORPH 25MG/ML AMPUL P/F.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INLYTA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P Q:180 /30Days |
INLYTA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P Q:60 /30Days |
INNOHEP 20000[iU]/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 2 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover INNOHEP 20000[iU]/mL 1 VIAL, MULTI-DOSE in 1 CARTON / 2 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | P Q:18 /30Days |
INNOPRAN CAPSULES EXTENDED RELEASE 120 MG ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN CAPSULES EXTENDED RELEASE 120 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INNOPRAN CAPSULES EXTENDED RELEASE 80 MG ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN CAPSULES EXTENDED RELEASE 80 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INSPRA 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INSPRA 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
Inspra 50mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Inspra 50mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INSULIN, GLULISINE, HUMAN 100 UNT/ML PREFILLED SYRINGE [APIDRA] 3 ML ![Compare how all Medicare Part D PDP plans in WI cover INSULIN, GLULISINE, HUMAN 100 UNT/ML PREFILLED SYRINGE [APIDRA] 3 ML .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:30 /28Days |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
Intelence 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Intelence 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
INTERMEZZO 1.75 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in WI cover INTERMEZZO 1.75 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INTERMEZZO 3.5 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in WI cover INTERMEZZO 3.5 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
INTRALIPID 20% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 20% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | P |
INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | P |
INTRON A 10MMU VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 10MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | P |
Intron A 11.6ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Intron A 11.6ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | P |
Intron A 19.2ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Intron A 19.2ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
Intron A 38.4ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Intron A 38.4ug/0.2mL 1 VIAL, MULTI-DOSE in 1 CARTON / 1.5 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
Introvale 3 CARTON in 1 BOX / 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in WI cover Introvale 3 CARTON in 1 BOX / 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | Q:91 /84Days |
Intuniv 1mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 1mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:30 /30Days |
Intuniv 2mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 2mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:30 /30Days |
Intuniv 3mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 3mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:30 /30Days |
Intuniv 4mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 4mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:30 /30Days |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:31 /31Days |
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:62 /31Days |
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:31 /31Days |
INVEGA ER 1.5mg/ 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover INVEGA ER 1.5mg/ 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | Q:31 /31Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 117 mg/0.75mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | Q:1 /28Days |
Invega Sustenna 156 mg/mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 156 mg/mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | Q:1 /28Days |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 234 mg/1.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | Q:2 /28Days |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 39 mg/0.25mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 78 mg/0.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | Q:1 /28Days |
INVIRASE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INVIRASE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
IONOSOL B-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL B-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
IONOSOL T-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL T-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
IOPIDINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in WI cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
Ipratropium Bromide 42ug/1 1 BOTTLE, SPRAY in 1 CARTON / 165 SPRAY, METERED in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in WI cover Ipratropium Bromide 42ug/1 1 BOTTLE, SPRAY in 1 CARTON / 165 SPRAY, METERED in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | Q:15 /10Days |
IPRATROPIUM BROMIDE NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BROMIDE NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | Q:30 /28Days |
IQUIX 1.5% DROPS ![Compare how all Medicare Part D PDP plans in WI cover IQUIX 1.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
IRBESARTAN 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IRBESARTAN 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IRBESARTAN 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IRBESARTAN-HCTZ 150-12.5 MG TB ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 150-12.5 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IRBESARTAN-HCTZ 300-12.5 MG TB ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 300-12.5 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IRESSA 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IRESSA 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IRINOTECAN HCL INJECTION 20MG ![Compare how all Medicare Part D PDP plans in WI cover IRINOTECAN HCL INJECTION 20MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
ISOCHRON 40MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover ISOCHRON 40MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOLYTE H IN 5% DEXTROSE ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE H IN 5% DEXTROSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISOLYTE M IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE M IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISOLYTE S IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE S IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISOLYTE S IV SOLUTION-EXCEL ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE S IV SOLUTION-EXCEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISONARIF 300-150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ISONARIF 300-150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISONIAZID 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISONIAZID INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISONIAZID TABLETS ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOPTIN SR 120MG ![Compare how all Medicare Part D PDP plans in WI cover ISOPTIN SR 120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOPTIN SR 180MG ![Compare how all Medicare Part D PDP plans in WI cover ISOPTIN SR 180MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOPTIN SR 240MG (500 Count) ![Compare how all Medicare Part D PDP plans in WI cover ISOPTIN SR 240MG (500 Count).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISORDIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISORDIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISORDIL TABLETS 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover ISORDIL TABLETS 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
Isosorbide Dinitrate 5mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Isosorbide Dinitrate 5mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE DINITRATE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE DINITRATE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE DN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE DN 2.5 MG TAB SL ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 2.5 MG TAB SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE DN 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE DN 30MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE MN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE MONONITRATE 20 MG ORAL TABLET [MONOKET] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE 20 MG ORAL TABLET [MONOKET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$74.00 | $148.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOTON GENTAMICIN 60MG/100ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTON GENTAMICIN 60MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |
ISTODAX KIT ![Compare how all Medicare Part D PDP plans in WI cover ISTODAX KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
ITRACONAZOLE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$10.00 | $20.00 | None |
IXEMPRA 45 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover IXEMPRA 45 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML ![Compare how all Medicare Part D PDP plans in WI cover IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$34.00 | $68.00 | None |