2015 Medicare Part D Plan Formulary Information |
Medica Prime Solution Enhanced w/Part D Option 2 (Cost) (H2450-002-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Medica Prime Solution Enhanced w/Part D Option 2 (Cost). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The Medica Prime Solution Enhanced w/Part D Option 2 (Cost) (H2450-002-0) Formulary Drugs Starting with the Letter I in WASHBURN County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $198.30 Deductible: $0 |
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE 3 MG/3 ML Syringe [Boniva] ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE 3 MG/3 ML Syringe [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:3 /84Days |
IBANDRONATE 3 MG/3 ML VIAL [Boniva] ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE 3 MG/3 ML VIAL [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:3 /84Days |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE SODIUM 150 MG TABLET [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | Q:1 /28Days |
IBRANCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:21 /28Days |
IBRANCE 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:21 /28Days |
IBRANCE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:21 /28Days |
IBUDONE 10; 200mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover IBUDONE 10; 200mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:150 /30Days |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IBUPROFEN 400MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 400MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
IBUPROFEN 600mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 600mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Ibuprofen 800mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ibuprofen 800mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
IDAMYCIN PFS 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IDAMYCIN PFS 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IDARUBICIN HCL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IDARUBICIN HCL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IFEX 1g/1 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in WI cover IFEX 1g/1 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
IFOSFAMIDE FOR INFECTION 1 GM ![Compare how all Medicare Part D PDP plans in WI cover IFOSFAMIDE FOR INFECTION 1 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
Ilaris 150mg/mL 1 VIAL, SINGLE-USE per CARTON / 1 mL in 1 VIAL, SINGLE-USE ![Compare how all Medicare Part D PDP plans in WI cover Ilaris 150mg/mL 1 VIAL, SINGLE-USE per CARTON / 1 mL in 1 VIAL, SINGLE-USE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ILEVRO 0.3% OPHTH DROPS ![Compare how all Medicare Part D PDP plans in WI cover ILEVRO 0.3% OPHTH DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
ILOTYCIN 0.5% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover ILOTYCIN 0.5% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IMBRUVICA 140 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 140 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:120 /30Days |
IMIPENEM-CILASTATIN 250 MG VL ![Compare how all Medicare Part D PDP plans in WI cover IMIPENEM-CILASTATIN 250 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IMIPENEM-CILASTATIN 500 MG VL ![Compare how all Medicare Part D PDP plans in WI cover IMIPENEM-CILASTATIN 500 MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE HCL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE PAMOATE 100MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 100MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE PAMOATE 125MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 125MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE PAMOATE 150MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 150MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIPRAMINE PAMOATE 75MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 75MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P |
IMIQUIMOD 5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover IMIQUIMOD 5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:24 /30Days |
IMITREX 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:18 /28Days |
IMITREX 20MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 20MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:12 /28Days |
IMITREX 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:18 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMITREX 4MG/0.5ML KIT REFILL ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 4MG/0.5ML KIT REFILL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:4 /28Days |
IMITREX 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:18 /28Days |
IMITREX 5MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 5MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:12 /28Days |
IMITREX 6MG/0.5ML SYRNG KIT ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 6MG/0.5ML SYRNG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:4 /28Days |
IMITREX 6MG/0.5ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover IMITREX 6MG/0.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:4 /28Days |
IMOVAX RABIES VACCINE ![Compare how all Medicare Part D PDP plans in WI cover IMOVAX RABIES VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | P |
IMURAN 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMURAN 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
INCRUSE ELLIPTA 62.5 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover INCRUSE ELLIPTA 62.5 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | S Q:30 /30Days |
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
INDAPAMIDE 2.5MG TABLET USP (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover INDAPAMIDE 2.5MG TABLET USP (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 120MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 160MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 60MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover INDERAL LA LONG ACTING CAPSULES 80MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT ![Compare how all Medicare Part D PDP plans in WI cover INDOCIN ORAL SUSPENSION 25MG/5ML 237 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
INDOMETHACIN 25MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 25MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:240 /30Days |
INDOMETHACIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:120 /30Days |
INDOMETHACIN 75MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 75MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | P Q:60 /30Days |
INLYTA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:180 /30Days |
INLYTA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P Q:60 /30Days |
INNOPRAN XL 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN XL 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INNOPRAN XL 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN XL 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INSPRA 50MG/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover INSPRA 50MG/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INSPRA 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INSPRA 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
Intelence 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Intelence 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
INTELENCE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
INTERMEZZO 1.75 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in WI cover INTERMEZZO 1.75 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P Q:30 /30Days |
INTERMEZZO 3.5 MG TAB SUBLING ![Compare how all Medicare Part D PDP plans in WI cover INTERMEZZO 3.5 MG TAB SUBLING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P Q:30 /30Days |
INTRALIPID 20% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 20% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID PHARMACY BULK PACKAGE FAT EMULSION 1.7-1.2-30GM 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
INTRON A 10MMU VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 10MMU VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTRON A 18 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 18 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
INTRON A 50 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 50 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | P |
Introvale 3 CARTON in 1 BOX / 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Introvale 3 CARTON in 1 BOX / 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | Q:91 /84Days |
Intuniv 1 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 1 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:30 /30Days |
Intuniv 2 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 2 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:30 /30Days |
Intuniv 3 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 3 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:30 /30Days |
Intuniv 4 MG ER 100 TABLET in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Intuniv 4 MG ER 100 TABLET in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:30 /30Days |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 3MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | S Q:30 /30Days |
INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 6MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR ![Compare how all Medicare Part D PDP plans in WI cover INVEGA 9MG TABLET SR OSMOTIC PUSH 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | S Q:30 /30Days |
INVEGA ER 1.5mg/ 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover INVEGA ER 1.5mg/ 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | S Q:30 /30Days |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 117 mg/0.75mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:1 /28Days |
Invega Sustenna 156 mg/mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 156 mg/mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:1 /28Days |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 234 mg/1.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | Q:2 /28Days |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 39 mg/0.25mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 78 mg/0.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | Q:1 /28Days |
INVIRASE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INVIRASE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
INVOKAMET 150-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 150-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:60 /30Days |
INVOKAMET 150-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 150-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVOKAMET 50-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 50-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:60 /30Days |
INVOKAMET 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:120 /30Days |
INVOKANA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKANA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:60 /30Days |
INVOKANA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKANA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | S Q:30 /30Days |
IONOSOL B-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL B-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IOPIDINE 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
IPOL SINGLE DOSE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover IPOL SINGLE DOSE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in WI cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
IPRATROPIUM BROMIDE 42ug/1 1 BOTTLE, SPRAY per CARTON / 165 SPRAY, METERED in 1 BOTTLE, SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BROMIDE 42ug/1 1 BOTTLE, SPRAY per CARTON / 165 SPRAY, METERED in 1 BOTTLE, SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | Q:15 /10Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IPRATROPIUM BROMIDE NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BROMIDE NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | Q:30 /28Days |
IRBESARTAN 150 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 150 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IRBESARTAN 300 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 300 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IRBESARTAN 75 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 75 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IRENKA DR 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IRENKA DR 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | Q:30 /30Days |
irinotecan hcl 100 mg/5 ml vl ![Compare how all Medicare Part D PDP plans in WI cover irinotecan hcl 100 mg/5 ml vl.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
ISENTRESS 100 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
ISENTRESS 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
ISENTRESS 25 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 25 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISOLYTE S IV SOLUTION-EXCEL ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE S IV SOLUTION-EXCEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISONIAZID 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
ISONIAZID 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$10.00 | $30.00 | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISONIAZID INJ 100MG/ML ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID INJ 100MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 10mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 20mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ISOPTO CARPINE 40mg/mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISORDIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISORDIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISORDIL TITRADOSE 5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover ISORDIL TITRADOSE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISOSORBIDE DINITRATE 40MG TABLETS EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE 40MG TABLETS EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE DN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE DN 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE DN 30MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE DN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE MN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE ER TABLET 30MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE TABLETS EXTENDED RELEASE 60MG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$79.00 | $237.00 | None |
ISTODAX KIT 10MG/VIAL ![Compare how all Medicare Part D PDP plans in WI cover ISTODAX KIT 10MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | P |
ITRACONAZOLE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] ![Compare how all Medicare Part D PDP plans in WI cover IVERMECTIN 3 MG TABLET [Stromectol, Sklice].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$29.00 | $87.00 | None |
IXEMPRA 45 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover IXEMPRA 45 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | 33% | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML ![Compare how all Medicare Part D PDP plans in WI cover IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$39.00 | $117.00 | None |