2013 Medicare Part D Plan Formulary Information |
Express Scripts Medicare - Value (PDP) (S5660-118-0)
Benefit Details
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The Express Scripts Medicare - Value (PDP) (S5660-118-0) Formulary Drugs Starting with the Letter O in CMS PDP Region 16 which includes: WI
|
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCELLA TABLET ![Compare how all Medicare Part D PDP plans in WI cover OCELLA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACETATE INJECTION 1000MCG 1X5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACETATE INJECTION 100MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACETATE INJECTION 500MCG 10 X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACETATE INJECTION SOLUTION 200MCG 1 X 5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACETATE INJECTION SOLUTION 50MCG 10X1ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in WI cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | None |
Ofloxacin 200mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ofloxacin 200mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Ofloxacin 300mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ofloxacin 300mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Ofloxacin 3mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Ofloxacin 3mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OFLOXACIN 400MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN 400MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN OPHTHALMIC SOLUTION 0.3% 5ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OGESTREL TABLET 0.05MG/0.5MG ![Compare how all Medicare Part D PDP plans in WI cover OGESTREL TABLET 0.05MG/0.5MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OLANZAPINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE 10 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OLANZAPINE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE ODT 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE ODT 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE-FLUOXETINE 12-25 MG ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 12-25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE-FLUOXETINE 12-50 MG ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 12-50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
olanzapine-fluoxetine 3-25 mg ![Compare how all Medicare Part D PDP plans in WI cover olanzapine-fluoxetine 3-25 mg.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE-FLUOXETINE 6-25 MG ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 6-25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLANZAPINE-FLUOXETINE 6-50 MG ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 6-50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OLSALAZINE 250 MG ORAL CAPSULE [DIPENTUM] ![Compare how all Medicare Part D PDP plans in WI cover OLSALAZINE 250 MG ORAL CAPSULE [DIPENTUM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
36% | 36% | None |
OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE 10MG CAPSULE DELAYED RELEASE (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:180 /90Days |
Omeprazole 20mg DELAYED RELEASE 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Omeprazole 20mg DELAYED RELEASE 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:180 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMEPRAZOLE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OMEPRAZOLE CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OMEPRAZOLE CAPSULES DELAYED RELEASE 40 MG ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE CAPSULES DELAYED RELEASE 40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:90 /90Days |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in WI cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
36% | 36% | P |
ONDANSETRON HCL 24 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON HCL 24 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P Q:21 /90Days |
Ondansetron HCl 4 mg/2 ml vial ![Compare how all Medicare Part D PDP plans in WI cover Ondansetron HCl 4 mg/2 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
ONDANSETRON HCL 4MG/5ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON HCL 4MG/5ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P |
Ondansetron Hydrochloride 4mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Ondansetron Hydrochloride 4mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P Q:135 /90Days |
ONDANSETRON HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P Q:135 /90Days |
ONDANSETRON ODT 4MG TABLET (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON ODT 4MG TABLET (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P Q:135 /90Days |
ONDANSETRON ODT 8MG (10 CT) ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON ODT 8MG (10 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | P Q:135 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ONFI 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONFI 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | None |
ONFI 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONFI 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | None |
ONFI 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONFI 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | None |
ONGLYZA 2.5mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover ONGLYZA 2.5mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:90 /90Days |
ONGLYZA 5mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover ONGLYZA 5mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:90 /90Days |
Onsolis 1200ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Onsolis 1200ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P Q:360 /90Days |
Onsolis 200ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Onsolis 200ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P Q:720 /90Days |
Onsolis 400ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Onsolis 400ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P Q:360 /90Days |
Onsolis 600ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Onsolis 600ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P Q:360 /90Days |
Onsolis 800ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Onsolis 800ug/1 30 PACKAGE in 1 CARTON / 1 FILM, SOLUBLE in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P Q:360 /90Days |
ONTAK INJECTION 300MCG/2ML VIALSU ![Compare how all Medicare Part D PDP plans in WI cover ONTAK INJECTION 300MCG/2ML VIALSU.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
36% | 36% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPANA ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPANA ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OPANA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPANA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OPANA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPANA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OPANA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPANA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OPANA ER 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPANA ER 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OPRELVEKIN 5 MG/ML INJECTABLE SOLUTION [NEUMEGA] ![Compare how all Medicare Part D PDP plans in WI cover OPRELVEKIN 5 MG/ML INJECTABLE SOLUTION [NEUMEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | P Q:63 /90Days |
ORAP 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORAP 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | None |
ORAP 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORAP 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | None |
ORENCIA 125mg/mL 4 SYRINGE, GLASS in 1 CARTON / 1 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in WI cover ORENCIA 125mg/mL 4 SYRINGE, GLASS in 1 CARTON / 1 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | P Q:12 /90Days |
ORFADIN CAPSULES 10 MG ![Compare how all Medicare Part D PDP plans in WI cover ORFADIN CAPSULES 10 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
ORFADIN CAPSULES 2 MG ![Compare how all Medicare Part D PDP plans in WI cover ORFADIN CAPSULES 2 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORFADIN CAPSULES 5 MG ![Compare how all Medicare Part D PDP plans in WI cover ORFADIN CAPSULES 5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
Orsythia 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Orsythia 6 BLISTER PACK in 1 CARTON / 1 KIT in 1 BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Ortho Evra 0.75; 6mg/7d; mg/7d 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Ortho Evra 0.75; 6mg/7d; mg/7d 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand Drugs |
36% | 36% | None |
OXALIPLATIN 5 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover OXALIPLATIN 5 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
OXANDROLONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXANDROLONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | P |
OXANDROLONE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover OXANDROLONE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | P |
OXAPROZIN 600MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXAPROZIN 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXCARBAZEPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 150MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXCARBAZEPINE 300MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 300MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXCARBAZEPINE 600MG TABLET 500 NCRC BOT ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 600MG TABLET 500 NCRC BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXSORALEN-ULTRA 10MG CAP ![Compare how all Medicare Part D PDP plans in WI cover OXSORALEN-ULTRA 10MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier Drugs |
25% | N/A | None |
OXYBUTYNIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | Q:360 /90Days |
Oxybutynin Chloride 5mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Oxybutynin Chloride 5mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | None |
OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CHLORIDE ER 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | Q:180 /90Days |
OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CHLORIDE ER 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | Q:90 /90Days |
OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CHLORIDE TABLET ER 15MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic Drugs |
$4.00 | $8.00 | Q:180 /90Days |
OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE AND ACETAMINOPHEN 325-5MG TABLET USP (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
Oxycodone and Acetaminophen 650; 10mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Oxycodone and Acetaminophen 650; 10mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:540 /90Days |
OXYCODONE AND ACETAMINOPHEN CAPSULES 500;5MG;MG 500 BOT ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE AND ACETAMINOPHEN CAPSULES 500;5MG;MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:720 /90Days |
OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE AND ACETAMINOPHEN TABLETS 2.5;325MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
OXYCODONE HCL 30MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:540 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL 5 MG/5 ML SOL ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 5 MG/5 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:3600 /90Days |
OXYCODONE HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL-ACETAMINOPHEN 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL-ACETAMINOPHEN 500-7.5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:720 /90Days |
Oxycodone Hydrochloride 100mg/5mL ![Compare how all Medicare Part D PDP plans in WI cover Oxycodone Hydrochloride 100mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1800 /90Days |
OXYCODONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:540 /90Days |
OXYCODONE HYDROCHLORIDE 20mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HYDROCHLORIDE 20mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:540 /90Days |
Oxycodone Hydrochloride 5mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Oxycodone Hydrochloride 5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
Oxycodone Hydrochloride and Aspirin 325; 4.8355mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Oxycodone Hydrochloride and Aspirin 325; 4.8355mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HYDROCHLORIDE TABLETS 15MG 100 TABLETS BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:540 /90Days |
OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | Q:1080 /90Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OxyContin 10mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 15mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 20mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 20mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 30mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 30mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 40mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 40mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 60mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
OxyContin 80mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 80mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:540 /90Days |
Oxymorphone hydrochloride 15mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Oxymorphone hydrochloride 15mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Oxymorphone hydrochloride 7.5mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Oxymorphone hydrochloride 7.5mg/1 100 TABLET, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXYMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
OXYMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic Drugs |
$7.00 | $14.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover OXYTROL 3.9mg/d 8 POUCH in 1 BOX / 1 PATCH in 1 POUCH / 4 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand Drugs |
25% | 25% | Q:32 /90Days |