2012 Medicare Part D Plan Formulary Information |
Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) (H5262-003-0)
Benefit Details
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The Gundersen Lutheran Senior Pref. Value (w/RX) (HMO) (H5262-003-0) Formulary Drugs Starting with the Letter E in La Crosse County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ECONAZOLE NITRATE 1% CREAM 85GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover ECONAZOLE NITRATE 1% CREAM 85GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ED K+10 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ED K+10 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
EDURANT 27.5mg/1 ![Compare how all Medicare Part D PDP plans in WI cover EDURANT 27.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:30 /30Days |
EES 400 TABLET 400MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover EES 400 TABLET 400MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
EFFEXOR 37.5MG CAPSULE ER (90 CT) ![Compare how all Medicare Part D PDP plans in WI cover EFFEXOR 37.5MG CAPSULE ER (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:180 /30Days |
EFFEXOR XR 150MG CAPSULE ER 15 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in WI cover EFFEXOR XR 150MG CAPSULE ER 15 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:60 /30Days |
EFFEXOR XR 75MG CAPSULE ER 15 CAPSULES BOT ![Compare how all Medicare Part D PDP plans in WI cover EFFEXOR XR 75MG CAPSULE ER 15 CAPSULES BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:90 /30Days |
Effient 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Effient 10mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Effient 5mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Effient 5mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WI cover ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELIDEL 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover ELIDEL 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:30 /1Days |
ELIGARD 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
ELIGARD 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
ELIGARD 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
ELIGARD 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT ![Compare how all Medicare Part D PDP plans in WI cover ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Elitek 3 KIT in 1 CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Elitek 3 KIT in 1 CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
ELMIRON 100mg/1 100 CAPSULE, GELATIN COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ELMIRON 100mg/1 100 CAPSULE, GELATIN COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
EMCYT 140MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMCYT 140MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
EMEND 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMEND 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:5 /1Days |
EMEND CAPSULES 125MG 6 BLPK ![Compare how all Medicare Part D PDP plans in WI cover EMEND CAPSULES 125MG 6 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:5 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMEND CAPSULES 80MG 2 BLPK ![Compare how all Medicare Part D PDP plans in WI cover EMEND CAPSULES 80MG 2 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:5 /1Days |
EMEND TRIFOLD PACK ![Compare how all Medicare Part D PDP plans in WI cover EMEND TRIFOLD PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:5 /1Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:30 /30Days |
EMTRIVA 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EMTRIVA 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
EMTRIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMTRIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
ENABLEX 15MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENABLEX 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | S Q:30 /30Days |
Enablex 7.5mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Enablex 7.5mg/1 30 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | S Q:30 /30Days |
ENALAPRIL MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Enalapril Maleate 2.5mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Enalapril Maleate 2.5mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Enalapril Maleate 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Enalapril Maleate 20mg/1 500 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Enalapril Maleate 5mg/1 1000 TABLET in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Enalapril Maleate 5mg/1 1000 TABLET in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE-HCTZ 10MG-25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ENBREL 25 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:8 /28Days |
ENBREL 25MG KIT ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:16 /28Days |
ENBREL 50mg/mL ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:8 /28Days |
ENDOCET 10/650MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 10/650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:180 /30Days |
ENDOCET 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:360 /30Days |
ENDOCET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:360 /30Days |
ENDOCET 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENDOCET 7.5/500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 7.5/500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:240 /30Days |
ENGERIX B INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX B INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P |
ENGERIX B INJECTION 20MCG/ML ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX B INJECTION 20MCG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P |
ENGERIX-B 10MCG 10 X 0.5ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX-B 10MCG 10 X 0.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:22 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:28 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:17 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:22 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:28 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:8 /30Days |
ENOXAPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:11 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENTOCORT EC 3MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ENTOCORT EC 3MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL ![Compare how all Medicare Part D PDP plans in WI cover ENULOSE SYRUP 10GM/15ML 1 PINT BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Epinephrine 0.1mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Epinephrine 0.1mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
EPIPEN 0.3MG AUTO-INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover EPIPEN 0.3MG AUTO-INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:1 /1Days |
EPIPEN JR 0.15MG AUTO-INJCT ![Compare how all Medicare Part D PDP plans in WI cover EPIPEN JR 0.15MG AUTO-INJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:1 /1Days |
EPITOL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPITOL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
EPIVIR 300mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR 300mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
EPIVIR HBV 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR HBV 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
EPIVIR HBV 25MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR HBV 25MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
EPIVIR ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
EPIVIR TABLETS ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Eplerenone 25mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Eplerenone 25mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Eplerenone 50mg/1 30 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Eplerenone 50mg/1 30 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
EPOGEN 10000U/ML VIAL MDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 10000U/ML VIAL MDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P |
EPOGEN 2000[iU]/mL 10 VIAL in 1 PACKAGE / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 2000[iU]/mL 10 VIAL in 1 PACKAGE / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P Q:12 /28Days |
EPOGEN 3000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 3000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | P Q:12 /28Days |
EPOGEN 4000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 4000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P Q:12 /28Days |
EPOGEN INJECTION 20000U 10 X 1ML CRTN ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN INJECTION 20000U 10 X 1ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P |
EPROSARTAN MESYLATE 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPROSARTAN MESYLATE 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
EPZICOM TABLETS ![Compare how all Medicare Part D PDP plans in WI cover EPZICOM TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
ERAXIS 100mg/30mL 30 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in WI cover ERAXIS 100mg/30mL 30 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P |
ERGOLOID MESYLATES TABLETS 1MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover ERGOLOID MESYLATES TABLETS 1MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERGOMAR SUBLINGUAL TABLET 2MG ![Compare how all Medicare Part D PDP plans in WI cover ERGOMAR SUBLINGUAL TABLET 2MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:20 /28Days |
ERIVEDGE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ERIVEDGE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:30 /30Days |
ERRIN 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ERRIN 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERY 2% PADS 2% 60 PADS JAR ![Compare how all Medicare Part D PDP plans in WI cover ERY 2% PADS 2% 60 PADS JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERY-TAB TAB 250MG EC ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB TAB 250MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ERY-TAB TAB 333MG EC ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB TAB 333MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROCIN 500MG ADDVNT VL ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROCIN 500MG ADDVNT VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P |
ERYTHROCIN TAB 250MG ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROCIN TAB 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROMYCIN 2% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 2% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Erythromycin 20mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Erythromycin 20mg/g 1 TUBE in 1 CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERYTHROMYCIN 500 MG FILMTAB ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 500 MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROMYCIN ETHYLSUCCINATE AND SULFISOXAZOLE ACETYL POWDER FOR ORAL SUSPENSION 200;600MG/5ML;MG/ 10 ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN ETHYLSUCCINATE AND SULFISOXAZOLE ACETYL POWDER FOR ORAL SUSPENSION 200;600MG/5ML;MG/ 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROMYCIN ETHYLSUCCINATE TABLETS 400 MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN ETHYLSUCCINATE TABLETS 400 MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ERYTHROMYCIN TAB 250MG BS ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN TAB 250MG BS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ERYTHROMYCIN-BENZOYL PEROXIDE 3-5% GEL ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN-BENZOYL PEROXIDE 3-5% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ESCITALOPRAM 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:45 /30Days |
ESCITALOPRAM 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:30 /30Days |
ESCITALOPRAM 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:30 /30Days |
ESCITALOPRAM OXALATE 5 MG/5 ML ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM OXALATE 5 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | Q:620 /30Days |
ESTRACE VAG CREAM 0.1MG/GM ![Compare how all Medicare Part D PDP plans in WI cover ESTRACE VAG CREAM 0.1MG/GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADERM 0.05MG/24H PATCH TRANSDERMAL SEMIWEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADERM 0.05MG/24H PATCH TRANSDERMAL SEMIWEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:8 /28Days |
ESTRADERM 0.1MG/24HR PATCH TRANSDERMAL SEMIWEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADERM 0.1MG/24HR PATCH TRANSDERMAL SEMIWEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:8 /28Days |
ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL .025MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL .0375MG/24 PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL .075MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.05MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.05MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.06MG/24H PATCH TRANSDERMAL WEEKLY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.1MG/DAY PATCH ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.1MG/DAY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | Q:4 /28Days |
ESTRADIOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ESTRADIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ESTRADIOL TABLET 1MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TABLET 1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL-NORETH 1.0-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL-NORETH 1.0-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ESTRING 2MG VAGINAL RING ![Compare how all Medicare Part D PDP plans in WI cover ESTRING 2MG VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:1 /90Days |
ESTROPIPATE 0.625 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 0.625 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ESTROPIPATE 1.25 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 1.25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ESTROPIPATE 2.5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 2.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETHAMBUTOL HCL 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ETHAMBUTOL HCL 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Ethambutol Hydrochloride 100mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Ethambutol Hydrochloride 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Ethosuximide 250mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Ethosuximide 250mg/1 100 CAPSULE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ETHOSUXIMIDE 250MG/5ML SYRP ![Compare how all Medicare Part D PDP plans in WI cover ETHOSUXIMIDE 250MG/5ML SYRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETIDRONATE DISODIUM 400MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover ETIDRONATE DISODIUM 400MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ETIDRONATE DISODIUM TABLETS 200MG 60 BOT ![Compare how all Medicare Part D PDP plans in WI cover ETIDRONATE DISODIUM TABLETS 200MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
ETODOLAC 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 400MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 400MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 500mg/1 ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 500mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
ETODOLAC 600MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 600MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |
Eurax Lotion and Cream 100mg/g 454 g in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Eurax Lotion and Cream 100mg/g 454 g in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
Eurax Lotion and Cream 100mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Eurax Lotion and Cream 100mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Evista 60mg/1 100 TABLET in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Evista 60mg/1 100 TABLET in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exelderm 10mg/g 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Exelderm 10mg/g 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
Exelderm 10mg/mL 30 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Exelderm 10mg/mL 30 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | None |
EXELON 1.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EXELON 1.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:60 /30Days |
EXELON 2MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EXELON 2MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:180 /30Days |
EXELON 3MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EXELON 3MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:60 /30Days |
EXELON 4.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EXELON 4.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:60 /30Days |
EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in WI cover EXELON 4.6MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
EXELON 6MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EXELON 6MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | Q:60 /30Days |
EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS ![Compare how all Medicare Part D PDP plans in WI cover EXELON 9.5MG/24HR PATCH TRANSDERMAL 24 HOURS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | None |
Exemestane 25mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exemestane 25mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$33.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXFORGE 10MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXFORGE 10MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
EXFORGE 10MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXFORGE 10MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
EXFORGE 5MG-160MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXFORGE 5MG-160MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
EXFORGE 5MG-320MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXFORGE 5MG-320MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exforge HCT 10; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exforge HCT 10; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exforge HCT 10; 25; 320mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exforge HCT 10; 25; 320mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exforge HCT 5; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exforge HCT 5; 12.5; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
Exforge HCT 5; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exforge HCT 5; 25; 160mg/1; mg/1; mg/1 30 TABLET, FILM COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$44.00 | N/A | Q:30 /30Days |
EXJADE 125MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | N/A | P |
EXJADE 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EXJADE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
EXTENDED PHENYTOIN SODIUM CAPSULES 300 MG ![Compare how all Medicare Part D PDP plans in WI cover EXTENDED PHENYTOIN SODIUM CAPSULES 300 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$9.00 | N/A | None |