2012 Medicare Part D Plan Formulary Information |
Advocare Vitality Rx (HMO-POS) (H5211-005-0)
Benefit Details
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The Advocare Vitality Rx (HMO-POS) (H5211-005-0) Formulary Drugs Starting with the Letter V in Barron County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VAGIFEM 10 MCG VAGINAL TAB ![Compare how all Medicare Part D PDP plans in WI cover VAGIFEM 10 MCG VAGINAL TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VALACYCLOVIR 1000 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover VALACYCLOVIR 1000 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VALACYCLOVIR 500 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover VALACYCLOVIR 500 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VALCYTE 450MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VALCYTE 450MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VALCYTE FOR ORAL SOLUTION 50MG/ML ![Compare how all Medicare Part D PDP plans in WI cover VALCYTE FOR ORAL SOLUTION 50MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VALPROIC ACID 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VALPROIC ACID 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT ![Compare how all Medicare Part D PDP plans in WI cover VALPROIC ACID SYRUP USP 250MG 16 FL OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VALTREX 1GM CAPLET (90 CT) ![Compare how all Medicare Part D PDP plans in WI cover VALTREX 1GM CAPLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VALTREX 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VALTREX 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Valturna 150; 160mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Valturna 150; 160mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](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 |
Valturna 300; 320mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Valturna 300; 320mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VANCOCIN HCL 125MG PULVULE ![Compare how all Medicare Part D PDP plans in WI cover VANCOCIN HCL 125MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VANCOCIN HCL 250MG PULVULE ![Compare how all Medicare Part D PDP plans in WI cover VANCOCIN HCL 250MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VANCOMYCIN HCL 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VANCOMYCIN HCL 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ) ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL INJECTION 10 X 1GM VIAL (STERILE ).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | P |
Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA ![Compare how all Medicare Part D PDP plans in WI cover Vancomycin Hydrochloride 100mg/mL 1 VIAL, PHARMACY BULK PACKAGE in 1 CASE / 95 mL in 1 VIAL, PHARMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | P |
VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE) ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HYDROCHLORIDE INJECTION (STERILE).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | P |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in WI cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Vandetanib 100mg/1 30 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vandetanib 100mg/1 30 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Vandetanib 300mg/1 30 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vandetanib 300mg/1 30 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VANOS 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover VANOS 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VAQTA 25 UNITS/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover VAQTA 25 UNITS/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in WI cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VASERETIC 10-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VASERETIC 10-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VASOTEC 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VASOTEC 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VASOTEC 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VASOTEC 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VASOTEC 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VASOTEC 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VASOTEC 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VASOTEC 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VECTICAL OINTMENT 3MCG/GM 100 GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover VECTICAL OINTMENT 3MCG/GM 100 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VELCADE 3.5MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover VELCADE 3.5MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Velivet Triphasic Regimen 3 POUCH in 1 CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT in 1 BLISTER PACK.](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 |
VELTIN 10; 0.25mg/g; mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover VELTIN 10; 0.25mg/g; mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VENLAFAXINE HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HCL 37.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 37.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HCL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HCL 75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HCL ER TAB 225 MG ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL ER TAB 225 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](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 |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HYDROCHLORIDE TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Ventavis 0.01mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Ventavis 0.01mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
VENTOLIN HFA 90MCG INHALER ![Compare how all Medicare Part D PDP plans in WI cover VENTOLIN HFA 90MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VERAMYST 27.5MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover VERAMYST 27.5MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VERAPAMIL 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL 2.5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 2.5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 240MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 100MG CAPSULE 24HR SR PELLETS.](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 |
VERAPAMIL ER 180 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 200MG CAPSULE 24HR SR PELLETS (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 300MG CAPSULE 24HR SR PELLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL HCL 120MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL HCL 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VERAPAMIL HCL 80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL HCL 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Verapamil Hydrochloride 120mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTEN ![Compare how all Medicare Part D PDP plans in WI cover Verapamil Hydrochloride 120mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, FILM COATED, EXTEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Verapamil Hydrochloride 240mg/1 500 TABLET, FILM COATED, EXTENDED RELEASE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VERELAN 120MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN 120MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VERELAN 180MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN 180MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VERELAN 240MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN 240MG CAP PELLET.](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 |
VERELAN 360MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN 360MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VERELAN PM 100MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN PM 100MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VERELAN PM 200MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN PM 200MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VERELAN PM 300MG CAP PELLET ![Compare how all Medicare Part D PDP plans in WI cover VERELAN PM 300MG CAP PELLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VESICARE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VESICARE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VESICARE 5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in WI cover VESICARE 5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VESTURA 3 MG-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VESTURA 3 MG-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VEXOL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover VEXOL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VFEND 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VFEND 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
VFEND 40MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover VFEND 40MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
VFEND 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VFEND 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIBRAMYCIN 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VIBRAMYCIN 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIBRAMYCIN 25MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover VIBRAMYCIN 25MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIBRAMYCIN 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover VIBRAMYCIN 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Vicodin 500; 5mg/1; mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Vicodin 500; 5mg/1; mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VICODIN ES TABLET 7.5-750 ![Compare how all Medicare Part D PDP plans in WI cover VICODIN ES TABLET 7.5-750.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VICODIN HP TABLET 10-660 ![Compare how all Medicare Part D PDP plans in WI cover VICODIN HP TABLET 10-660.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | None |
VICOPROFEN 200/7.5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover VICOPROFEN 200/7.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VICTOZA 3-PAK 18 MG/3 ML PEN ![Compare how all Medicare Part D PDP plans in WI cover VICTOZA 3-PAK 18 MG/3 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | P |
VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VICTRELIS 200mg/1 4 TRAY in 1 CARTON / 7 BOTTLE in 1 TRAY / 12 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU ![Compare how all Medicare Part D PDP plans in WI cover VIDAZA FOR INJECTION 100MG/VIAL 1 VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
VIDEX 2GM PEDIATRIC TUBEX ![Compare how all Medicare Part D PDP plans in WI cover VIDEX 2GM PEDIATRIC 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 |
VIDEX EC 125MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover VIDEX EC 125MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIDEX EC 200MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover VIDEX EC 200MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIDEX EC 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover VIDEX EC 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIDEX EC 400MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover VIDEX EC 400MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL] ![Compare how all Medicare Part D PDP plans in WI cover VIGABATRIN 50 MG/ML ORAL SOLUTION [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIGABATRIN 500 MG ORAL TABLET [SABRIL] ![Compare how all Medicare Part D PDP plans in WI cover VIGABATRIN 500 MG ORAL TABLET [SABRIL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIGAMOX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover VIGAMOX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIIBRYD 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover VIIBRYD 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIIBRYD 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VIIBRYD 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIIBRYD 20mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VIIBRYD 20mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIIBRYD 40mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VIIBRYD 40mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](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 |
VIMPAT 10 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover VIMPAT 10 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vimpat 100mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vimpat 100mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WI cover Vimpat 10mg/mL 10 VIAL, GLASS in 1 CARTON / 20 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vimpat 150mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vimpat 150mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vimpat 200mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vimpat 200mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vimpat 50mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Vimpat 50mg/1 60 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIRACEPT 50MG/GM ORAL POWDER ![Compare how all Medicare Part D PDP plans in WI cover VIRACEPT 50MG/GM ORAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIRAMUNE 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIRAMUNE 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Viramune 400mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE.](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 |
VIRAMUNE 50MG/5ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover VIRAMUNE 50MG/5ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIRAZOLE 6GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover VIRAZOLE 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIREAD 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIREAD 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIREAD 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIREAD 300MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIREAD POWDER ![Compare how all Medicare Part D PDP plans in WI cover VIREAD POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIROPTIC 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover VIROPTIC 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VISTARIL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VISTARIL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VISTARIL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VISTARIL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VISTIDE 75MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover VISTIDE 75MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIVACTIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIVACTIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VIVACTIL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIVACTIL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in WI cover Vivelle Dot 0.025mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 ![Compare how all Medicare Part D PDP plans in WI cover Vivelle Dot 0.0375mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P ![Compare how all Medicare Part D PDP plans in WI cover Vivelle Dot 0.05mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 P.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA ![Compare how all Medicare Part D PDP plans in WI cover Vivelle Dot 0.1mg/d 3 PACKET in 1 CARTON / 8 POUCH in 1 PACKET / 1 PATCH in 1 POUCH / 3.5 d in 1 PA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN ![Compare how all Medicare Part D PDP plans in WI cover VIVELLE-DOT 0.075MG PATCH 1X3X8 POUCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$35.00 | $105.00 | None |
VOLTAREN 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover VOLTAREN 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Voltaren 10mg/g ![Compare how all Medicare Part D PDP plans in WI cover Voltaren 10mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VOLTAREN-XR 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover VOLTAREN-XR 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
Voriconazole 200mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Voriconazole 200mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Voriconazole 50mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Voriconazole 50mg/1 30 TABLET, FILM COATED in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
$6.00 | $18.00 | P |
VOTRIENT 200mg/1 120 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VOTRIENT 200mg/1 120 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
33% | N/A | P |
VYTORIN 10/10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover VYTORIN 10/10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYTORIN 10/20MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover VYTORIN 10/20MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYTORIN 10/40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover VYTORIN 10/40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYTORIN 10/80MG TABLET 2500 BOT ![Compare how all Medicare Part D PDP plans in WI cover VYTORIN 10/80MG TABLET 2500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYVANSE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYVANSE 40MG CAPSULE 100 EA ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 40MG CAPSULE 100 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYVANSE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYVANSE 70MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 70MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |
VYVANSE CAPSULES 20MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE CAPSULES 20MG 100 BOT.](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 |
VYVANSE CAPSULES 60MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE CAPSULES 60MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$70.00 | $210.00 | None |