2015 Medicare Part D Plan Formulary Information |
HealthPartners Wisconsin Freedom Balance with Rx (Cost) (H2462-017-0)
Benefit Details
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The HealthPartners Wisconsin Freedom Balance with Rx (Cost) (H2462-017-0) Formulary Drugs Starting with the Letter C in BURNETT County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $229.80 Deductible: $320 |
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Calcipotriene 50ug/g 60 g per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Calcipotriene 50ug/g 60 g per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CALCIPOTRIENE TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Calcipotriene-Betamethasone Dipropionate Ointment [Taclonex] ![Compare how all Medicare Part D PDP plans in WI cover Calcipotriene-Betamethasone Dipropionate Ointment [Taclonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in WI cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CALCITRIOL 0.25MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.25MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CALCITRIOL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Calcitriol 1 mcg/ml ampul ![Compare how all Medicare Part D PDP plans in WI cover Calcitriol 1 mcg/ml ampul.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CALCITRIOL 3 MCG/G OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 3 MCG/G OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCIUM ACETATE CAPSULE 667 MG ![Compare how all Medicare Part D PDP plans in WI cover CALCIUM ACETATE CAPSULE 667 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CAMILA 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAMILA 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX ![Compare how all Medicare Part D PDP plans in WI cover CANASA RECTAL SUPPOSITORIES 1000MG 30 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in WI cover CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CAPRELSA 100mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 100mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
CAPRELSA 300mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 300mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CAPTOPRIL 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in WI cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
Carbaglu 200mg/1 5 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Carbaglu 200mg/1 5 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CARBAMAZEPINE 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbamazepine 100mg, CHEWABLE 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Carbamazepine 100mg, CHEWABLE 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Carbamazepine 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Carbamazepine 100mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbamazepine 200mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Carbamazepine 200mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carbamazepine 300mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Carbamazepine 300mg/1 120 CAPSULE, EXTENDED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBAMAZEPINE TABLET USP 200MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE TABLET USP 200MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBAMAZEPINE XR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBAMAZEPINE XR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBIDOPA 25 MG TABLET [Lodosyn] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA 25 MG TABLET [Lodosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa and Levodopa 25; 100mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa and Levodopa 25; 100mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa and Levodopa 50; 200mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa and Levodopa 50; 200mg/1; mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 TABLET, EXTENDED .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa-Levodopa-Entacapone 100 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 100 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa-Levodopa-Entacapone 125 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 125 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa-Levodopa-Entacapone 150 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 150 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa-Levodopa-Entacapone 200 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 200 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carbidopa-Levodopa-Entacapone 50 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 50 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carbidopa-Levodopa-Entacapone 75 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover Carbidopa-Levodopa-Entacapone 75 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBIDOPA/LEVO 10/100 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA/LEVO 10/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBIDOPA/LEVO 25/100 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA/LEVO 25/100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARBIDOPA/LEVO 25/250 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA/LEVO 25/250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carboplatin 10mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Carboplatin 10mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CARIMUNE NF 6GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CARIMUNE NF 6GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CARTEOLOL HCL OPHTHALMIC SOLUTION USP 1% 15ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTIA XT 300MG CAPSULE SR 24 HR ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 300MG CAPSULE SR 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Carvedilol 12.5mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Carvedilol 12.5mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Carvedilol 25mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Carvedilol 25mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Carvedilol 3.125mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Carvedilol 3.125mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Carvedilol 6.25mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Carvedilol 6.25mg 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CAYSTON KIT 75 MG/VIAL ![Compare how all Medicare Part D PDP plans in WI cover CAYSTON KIT 75 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P Q:84 /30Days |
CEFADROXIL 1G TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFADROXIL 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefadroxil 500mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cefadroxil 500mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefadroxil 500mg/5mL ![Compare how all Medicare Part D PDP plans in WI cover Cefadroxil 500mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFAZOLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFAZOLIN 500MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 500MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 250MG/5ML SUSPENSION RECONSTITUTED ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFDINIR CAPSULES 300MG (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR CAPSULES 300MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR FOR ORAL SUSPENSION 125MG/5ML (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFEPIME HCL 2 GRAM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME HCL 2 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFEPIME INJ 1GM 20ML APX 10x1G VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME INJ 1GM 20ML APX 10x1G VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefoxitin 1g/1 10 POWDER per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Cefoxitin 1g/1 10 POWDER per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefoxitin 2g/1 10 POWDER per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Cefoxitin 2g/1 10 POWDER per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFPODOXIME 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT) ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME PROXETIL FILM COATED TABLET 100MG (20 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
cefprozil 125 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in WI cover cefprozil 125 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
cefprozil 250 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in WI cover cefprozil 250 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefprozil 250mg 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cefprozil 250mg 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFPROZIL TABLETS 500MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL TABLETS 500MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFTIN 250MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFTIN 250MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CEFTRIAXONE 10GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 10GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFTRIAXONE 250 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 250 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Ceftriaxone Sodium 500mg ![Compare how all Medicare Part D PDP plans in WI cover Ceftriaxone Sodium 500mg.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 1.5 GM/VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEFUROXIME 750 MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 750 MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cefuroxime Axetil 250 MG ![Compare how all Medicare Part D PDP plans in WI cover Cefuroxime Axetil 250 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cefuroxime Axetil 500mg ![Compare how all Medicare Part D PDP plans in WI cover Cefuroxime Axetil 500mg.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CELLCEPT IV INJ 500 MG ![Compare how all Medicare Part D PDP plans in WI cover CELLCEPT IV INJ 500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
CELONTIN 300 MG KAPSEAL ![Compare how all Medicare Part D PDP plans in WI cover CELONTIN 300 MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Cephalexin 125mg/5mL 200 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cephalexin 125mg/5mL 200 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEPHALEXIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CEPHALEXIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CEPHALEXIN 250 MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CEPHALEXIN CAPSULES 500 MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN CAPSULES 500 MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CERDELGA 84 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CERDELGA 84 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CEREZYME 400 UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEREZYME 400 UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
CERVARIX VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover CERVARIX VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Cetirizine Hydrochloride 1mg/mL 120 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cetirizine Hydrochloride 1mg/mL 120 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CEVIMELINE HCL 30 MG CAPSULE [Evoxac] ![Compare how all Medicare Part D PDP plans in WI cover CEVIMELINE HCL 30 MG CAPSULE [Evoxac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHANTIX 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CHANTIX 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CHANTIX 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Chantix 1.0mg/1 56 FILM COATED TABLETS in BOX ![Compare how all Medicare Part D PDP plans in WI cover Chantix 1.0mg/1 56 FILM COATED TABLETS in BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHEMET 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHEMET 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CHLORAMPHEN NA SUCC 1GM VL ![Compare how all Medicare Part D PDP plans in WI cover CHLORAMPHEN NA SUCC 1GM VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CHLORDIAZEPOXIDE HCL 10mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE HCL 10mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:180 /30Days |
CHLORDIAZEPOXIDE HCL 25mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE HCL 25mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:120 /30Days |
CHLORDIAZEPOXIDE HCL 5mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE HCL 5mg 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE in 1 BLISTER .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:180 /30Days |
CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH ![Compare how all Medicare Part D PDP plans in WI cover CHLORHEXIDINE GLUCONATE 0.12% MOUTHWASH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CHLOROQUINE PH 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PH 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLOROQUINE PHOSPHATE 250 MG TABLET (50 CT) ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PHOSPHATE 250 MG TABLET (50 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLOROTHIAZIDE 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROTHIAZIDE 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Chlorothiazide 500mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Chlorothiazide 500mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CHLORPROMAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLORPROMAZINE 25 MG/ML AMP ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 25 MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLORPROMAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLORPROMAZINE HCL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE HCL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Chlorpromazine Hydrochloride 100mg SUGAR COATED 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Chlorpromazine Hydrochloride 100mg SUGAR COATED 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLORTHALIDONE 25 MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 25 MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHLORTHALIDONE 50 MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 50 MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CHOLESTYRAMINE LIGHT POWDER FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CHORIONIC GONAD 10000U VIAL ![Compare how all Medicare Part D PDP plans in WI cover CHORIONIC GONAD 10000U VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
Ciclopirox 7.7mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ciclopirox 7.7mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6 ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 8% TOPICAL SOLUTION NAIL LACQUER 6.6 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CICLOPIROX GEL ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Ciclopirox Olamine 7.7mg/g 1 TUBE in 1 TUBE / 15 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Ciclopirox Olamine 7.7mg/g 1 TUBE in 1 TUBE / 15 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cilostazol 50mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cilostazol 50mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CILOSTAZOL TABLET 100MG (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover CILOSTAZOL TABLET 100MG (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CIMETIDINE 300 MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover CIMETIDINE 300 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cimetidine 400mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 400mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIMZIA 200 MG/ML SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover CIMZIA 200 MG/ML SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CIPRO HC OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CIPRO HC OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CIPROFLOXACIN 0.3% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 0.3% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CIPROFLOXACIN 250 MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 250 MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CIPROFLOXACIN 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Ciprofloxacin 400mg/40mL 1 VIAL per CARTON / 40 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Ciprofloxacin 400mg/40mL 1 VIAL per CARTON / 40 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CIPROFLOXACIN 500 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 500 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Ciprofloxacin and Dextrose 2mg/mL 24 BAG in 1 CASE / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in WI cover Ciprofloxacin and Dextrose 2mg/mL 24 BAG in 1 CASE / 100 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CIPROFLOXACIN HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN HCL 500 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CIPROFLOXACIN TABLETS 750 MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN TABLETS 750 MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Cisplatin 100mg/100mL 1 VIAL per CARTON / 100 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Cisplatin 100mg/100mL 1 VIAL per CARTON / 100 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CITALOPRAM HBR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CITALOPRAM HBR ORAL SOLUTION 10MG 240 ML BOTPL ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR ORAL SOLUTION 10MG 240 ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CITALOPRAM HYDROBROMIDE TABLETS 40 MG 30 BOT ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HYDROBROMIDE TABLETS 40 MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CITOLOPRAM HBR 10 MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CITOLOPRAM HBR 10 MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
Cladribine 10 mg/10 ml vial ![Compare how all Medicare Part D PDP plans in WI cover Cladribine 10 mg/10 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLARAVIS 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLARAVIS 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARAVIS 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLARITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLARITHROMYCIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Clemastine Fumarate 0.5mg/5mL 120 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Clemastine Fumarate 0.5mg/5mL 120 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLEOCIN 100 MG VAGINAL OVULE ![Compare how all Medicare Part D PDP plans in WI cover CLEOCIN 100 MG VAGINAL OVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG ![Compare how all Medicare Part D PDP plans in WI cover CLIMARA PRO DIS WEEKLY 4.40MG/1.39MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CLINDAMYCIN 150MG/ML ADDVAN ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN 150MG/ML ADDVAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN HCL 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN HCL 300 MG 100 CAPSULE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 300 MG 100 CAPSULE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN PEDIATR 75 MG/5 ML ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PEDIATR 75 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN PHOSP 1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSP 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
clindamycin phosphate 10mg/mL 1 BOTTLE per CARTON / 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover clindamycin phosphate 10mg/mL 1 BOTTLE per CARTON / 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOBETASOL E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Clobetasol Propionate 0.4625mg/mL 1 BOTTLE per CARTON / 50 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Clobetasol Propionate 0.4625mg/mL 1 BOTTLE per CARTON / 50 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOLAR 20 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CLOLAR 20 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CLOMIPRAMINE HCL 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE HCL 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLOMIPRAMINE HCL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE HCL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLOMIPRAMINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Clonazepam 0.125mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PAC ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 0.125mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING in 1 BLISTER PAC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:180 /30Days |
Clonazepam 0.25mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 0.25mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:180 /30Days |
Clonazepam 0.5mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 0.5mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:180 /30Days |
Clonazepam 0.5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 0.5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | Q:180 /30Days |
Clonazepam 1mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 1mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:120 /30Days |
Clonazepam 1mg/1 90 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 1mg/1 90 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | Q:120 /30Days |
Clonazepam 2mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 2mg/1 10 BLISTER PACK per CARTON / 6 TABLET, ORALLY DISINTEGRATING per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:300 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clonazepam 2mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Clonazepam 2mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | Q:300 /30Days |
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLONIDINE HCL 0.2MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.2MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CLONIDINE HCL ER 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL ER 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P Q:4 /1Days |
CLONIDINE HCL TABLET 0.1MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL TABLET 0.1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CLONIDINE HCL TABLET 0.3MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL TABLET 0.3MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CLOPIDOGREL 300 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in WI cover CLOPIDOGREL 300 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in WI cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | None |
CLORAZEPATE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clorazepate Dipotassium 3.75mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Clorazepate Dipotassium 3.75mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:180 /30Days |
Clorazepate Dipotassium 7.5mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Clorazepate Dipotassium 7.5mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:180 /30Days |
CLOTRIMAZOLE 10MG TROCHE ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 10MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Clozapine 100mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Clozapine 100mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOZAPINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOZAPINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOZAPINE 50MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 50MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CLOZAPINE ODT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLOZAPINE ODT 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLOZAPINE ODT 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CLOZAPINE ODT 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
COARTEM 20MG-120MG ![Compare how all Medicare Part D PDP plans in WI cover COARTEM 20MG-120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CODEINE SULFATE 15 MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover CODEINE SULFATE 15 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:240 /30Days |
CODEINE SULFATE 30 MG TABLET 3100 ![Compare how all Medicare Part D PDP plans in WI cover CODEINE SULFATE 30 MG TABLET 3100.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:240 /30Days |
Codeine sulfate 60mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Codeine sulfate 60mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | Q:240 /30Days |
COLCHICINE 0.6 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover COLCHICINE 0.6 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COLCHICINE 0.6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COLCHICINE 0.6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COLCRYS 0.6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COLCRYS 0.6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in WI cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
colistimethate 150mg/2mL 1 VIAL per CARTON / 2 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover colistimethate 150mg/2mL 1 VIAL per CARTON / 2 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover COLLAGENASE SANTYL OINTMENT 250UNT 30GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLOCORT 100MG ENEMA ![Compare how all Medicare Part D PDP plans in WI cover COLOCORT 100MG ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COMBIGAN 0.2%-0.5% DROPS ![Compare how all Medicare Part D PDP plans in WI cover COMBIGAN 0.2%-0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
COMBIPATCH 0.05/0.14MG PTCH ![Compare how all Medicare Part D PDP plans in WI cover COMBIPATCH 0.05/0.14MG PTCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
COMBIPATCH 0.05/0.25MG PTCH ![Compare how all Medicare Part D PDP plans in WI cover COMBIPATCH 0.05/0.25MG PTCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
COMBIVENT RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover COMBIVENT RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
COMETRIQ 100 MG DAILY-DOSE PK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 100 MG DAILY-DOSE PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
COMETRIQ 140 MG DAILY-DOSE PK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 140 MG DAILY-DOSE PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
COMETRIQ 60 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 60 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in WI cover COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | None |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in WI cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COMVAX VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover COMVAX VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CONDYLOX GEL 0.5% 3.5 GM CRTN ![Compare how all Medicare Part D PDP plans in WI cover CONDYLOX GEL 0.5% 3.5 GM CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
CONSTULOSE 10 GM/15 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover CONSTULOSE 10 GM/15 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in WI cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
COPAXONE 40 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover COPAXONE 40 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CORDRAN TAPE 4MCG/SQCM 1 X 80 X 3 CTR ![Compare how all Medicare Part D PDP plans in WI cover CORDRAN TAPE 4MCG/SQCM 1 X 80 X 3 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | P |
COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in WI cover COREG CR 10MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | S |
COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in WI cover COREG CR 20MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | S |
COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in WI cover COREG CR 40MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | S |
COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR ![Compare how all Medicare Part D PDP plans in WI cover COREG CR 80MG CAPSULE MULTIPHASIC RELEASE 24 HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | S |
COSENTYX 150 MG/ML PEN INJECT ![Compare how all Medicare Part D PDP plans in WI cover COSENTYX 150 MG/ML PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
COSENTYX 300 MG DOSE-2 PENS ![Compare how all Medicare Part D PDP plans in WI cover COSENTYX 300 MG DOSE-2 PENS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COSMEGEN 0.5 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover COSMEGEN 0.5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CREON DR 36,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CREON DR 36,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CRESEMBA 186 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CRESEMBA 186 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CRIXIVAN 400mg, 180 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 400mg, 180 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CROMOLYN NEBULIZER SOLUTION 20MG/2ML ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN NEBULIZER SOLUTION 20MG/2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CUPRIMINE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CUPRIMINE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
CUVPOSA 1 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CUVPOSA 1 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | None |
Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cyclafem 7/7/7 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclafem 7/7/7 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
Cyclobenzaprine 7.5 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Cyclobenzaprine 7.5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | P |
CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE HCL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | P |
Cyclobenzaprine Hydrochloride 5mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Cyclobenzaprine Hydrochloride 5mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
25% | 25% | P |
CYCLOPHOSPHAMIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYCLOSET 0.8MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSET 0.8MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | 25% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Cyclosporine 100mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclosporine 100mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Cyclosporine 25mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclosporine 25mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Cyclosporine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Cyclosporine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
Cyclosporine 50mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclosporine 50mg 30 BLISTER PACK per CARTON / 1 CAPSULE, LIQUID FILLED per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYPROHEPTADINE HCL 4 MG ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE HCL 4 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | None |
CYSTADANE POWDER FOR ORAL SOLUTION 180GM ![Compare how all Medicare Part D PDP plans in WI cover CYSTADANE POWDER FOR ORAL SOLUTION 180GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
25% | 25% | None |
CYSTARAN 0.44% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover CYSTARAN 0.44% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | 25% | P |
CYTARABINE 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CYTARABINE 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
25% | 25% | P |