2015 Medicare Part D Plan Formulary Information |
Anthem MediBlue Select (HMO) (H9525-004-0)
Benefit Details
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The Anthem MediBlue Select (HMO) (H9525-004-0) Formulary Drugs Starting with the Letter M in MILWAUKEE County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $23.00 Deductible: $131 |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in WI cover M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Magnesium sulfate 50% vial ![Compare how all Medicare Part D PDP plans in WI cover Magnesium sulfate 50% vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MAGNESIUM SULFATE INJECTION 5 GM/10ML ![Compare how all Medicare Part D PDP plans in WI cover MAGNESIUM SULFATE INJECTION 5 GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Malathion 5mg/mL 1 BOTTLE per CARTON / 59 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Malathion 5mg/mL 1 BOTTLE per CARTON / 59 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MAPROTILINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:270 /30Days |
MAPROTILINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:135 /30Days |
MAPROTILINE 75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MARLISSA-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MARLISSA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MARPLAN 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover MARPLAN 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MATULANE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MATULANE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover MECLIZINE HYDROCHLORIDE TABLETS 12.5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover MECLIZINE HYDROCHLORIDE TABLETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MECLOFENAMATE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MECLOFENAMATE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MECLOFENAMATE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MECLOFENAMATE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Medroxyprogesterone Acetate 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Medroxyprogesterone Acetate 2.5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Medroxyprogesterone Acetate 5mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE ACETATE INJECTION SUSPENSION 150MG 1 VIALSD CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Mefenamic Acid 250mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Mefenamic Acid 250mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MEFLOQUINE HCL 250MG TABLET 25 BOT ![Compare how all Medicare Part D PDP plans in WI cover MEFLOQUINE HCL 250MG TABLET 25 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MEGESTROL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEGESTROL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEGESTROL ACETATE 40MG TABLET (250 CT) ![Compare how all Medicare Part D PDP plans in WI cover MEGESTROL ACETATE 40MG TABLET (250 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Megestrol Acetate 40mg/mL 480 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
MEKINIST 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEKINIST 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
MEKINIST 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEKINIST 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
MELOXICAM 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MELOXICAM 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | Q:30 /30Days |
MELOXICAM 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MELOXICAM 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | Q:30 /30Days |
MELOXICAM 7.5MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in WI cover MELOXICAM 7.5MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:300 /30Days |
MELPHALAN 5 MG/ML INJECTABLE SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MELPHALAN 5 MG/ML INJECTABLE SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL ![Compare how all Medicare Part D PDP plans in WI cover Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MENEST 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MENEST 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MENEST 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MENEST 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MENOMUNE-A/C/Y/W-135 VIAL ![Compare how all Medicare Part D PDP plans in WI cover MENOMUNE-A/C/Y/W-135 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MENVEO INJECTION KIT ![Compare how all Medicare Part D PDP plans in WI cover MENVEO INJECTION KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MEPRON 750MG/5ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover MEPRON 750MG/5ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
MERCAPTOPURINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MERCAPTOPURINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MEROPENEM 500MG/VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover MEROPENEM 500MG/VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Mesalamine 1 KIT per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Mesalamine 1 KIT per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Mesna 100 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Mesna 100 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MESNEX 100MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in WI cover MESNEX 100MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MESNEX 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MESNEX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MESTINON 180MG TIMESPAN ![Compare how all Medicare Part D PDP plans in WI cover MESTINON 180MG TIMESPAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MESTINON 60MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover MESTINON 60MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
METFORMIN HCL 1000MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL 1000MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:76 /30Days |
METFORMIN HCL 500MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL 500MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:153 /30Days |
METFORMIN HCL ER 1,000 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 1,000 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | Q:75 /30Days |
METFORMIN HCL ER 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | Q:120 /30Days |
Metformin Hydrochloride 750mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Metformin Hydrochloride 750mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | Q:80 /30Days |
METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HYDROCHLORIDE 850mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Select Care Drugs |
$0.00 | $0.00 | Q:90 /30Days |
METHADONE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover METHADONE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:360 /30Days |
METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover METHADONE HYDROCHLORIDE 10mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:180 /30Days |
Methadone Hydrochloride 10mg/5mL ![Compare how all Medicare Part D PDP plans in WI cover Methadone Hydrochloride 10mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:900 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methadone Hydrochloride 5mg/5mL ![Compare how all Medicare Part D PDP plans in WI cover Methadone Hydrochloride 5mg/5mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1800 /30Days |
METHAZOLAMIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHAZOLAMIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METHAZOLAMIDE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHAZOLAMIDE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Methenamine Hippurate 1g/1 ![Compare how all Medicare Part D PDP plans in WI cover Methenamine Hippurate 1g/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METHIMAZOLE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHIMAZOLE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METHIMAZOLE 5MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover METHIMAZOLE 5MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
methotrexate 1 gm vial ![Compare how all Medicare Part D PDP plans in WI cover methotrexate 1 gm vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METHOTREXATE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHOTREXATE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Methotrexate 25 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Methotrexate 25 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Methoxsalen 10 mg Capsule [8-MOP] ![Compare how all Medicare Part D PDP plans in WI cover Methoxsalen 10 mg Capsule [8-MOP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
METHSCOPOLAMINE BROMIDE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHSCOPOLAMINE BROMIDE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHSCOPOLAMINE BROMIDE 5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METHSCOPOLAMINE BROMIDE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
METHYCLOTHIAZIDE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYCLOTHIAZIDE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
Methylergonovine Maleate 0.2mg/1 28 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Methylergonovine Maleate 0.2mg/1 28 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METHYLPHENIDATE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:90 /30Days |
METHYLPHENIDATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:90 /30Days |
METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE HYDROCHLORIDE 5mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P Q:90 /30Days |
methylprednisolone 125 mg vial ![Compare how all Medicare Part D PDP plans in WI cover methylprednisolone 125 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METHYLPREDNISOLONE 16MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 16MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METHYLPREDNISOLONE 32MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 32MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
methylprednisolone 40 mg vial ![Compare how all Medicare Part D PDP plans in WI cover methylprednisolone 40 mg vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Methylprednisolone 40mg/mL 1 VIAL, MULTI-DOSE per CARTON / 5 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Methylprednisolone 4mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Methylprednisolone 4mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METHYLPREDNISOLONE 8 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 8 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS per CARTON / 1 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WI cover Methylprednisolone acetate 80mg/mL 25 VIAL, GLASS per CARTON / 1 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE TABLET 4MG 21 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METIPRANOLOL 0.3% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover METIPRANOLOL 0.3% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Metoclopramide 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOCLOPRAMIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOCLOPRAMIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOCLOPRAMIDE 5 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover METOCLOPRAMIDE 5 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Metoclopramide 5mg/mL 25 VIAL in 1 TRAY / 2 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METOLAZONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOLAZONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOLAZONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOPROLOL SUCC ER 100 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METOPROLOL SUCC ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METOPROLOL SUCCINATE ER 200 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCCINATE ER 200 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METOPROLOL SUCCINATE ER 25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCCINATE ER 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Metoprolol Tartrate 1mg/mL 3 AMPULE in 1 CARTON / 5 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in WI cover Metoprolol Tartrate 1mg/mL 3 AMPULE in 1 CARTON / 5 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METOPROLOL TARTRATE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE TABLET USP 100MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE TABLET USP 100MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HYDROCHLOROTHIAZIDE 100MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METRONIDAZOLE 0.75% CREAM ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 0.75% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
METRONIDAZOLE 0.75% LOTION ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 0.75% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
metronidazole 375 mg capsule ![Compare how all Medicare Part D PDP plans in WI cover metronidazole 375 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Metronidazole 500mg/100mL 24 BAG per CARTON / 100 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in WI cover Metronidazole 500mg/100mL 24 BAG per CARTON / 100 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
METRONIDAZOLE TABLETS USP 250MG 250 BOTPL ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE TABLETS USP 250MG 250 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METRONIDAZOLE TABLETS USP 500MG 100 BOTPL ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE TABLETS USP 500MG 100 BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE TOPICAL GEL 0.75% 45GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
METRONIDAZOLE VAGINAL GEL ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE VAGINAL GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MEXILETINE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MEXILETINE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEXILETINE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Micardis 20mg/1 3 BLISTER PACK per CARTON / 10 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Micardis 20mg/1 3 BLISTER PACK per CARTON / 10 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
MICARDIS 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
MICARDIS 80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
MICONAZOLE 3 200MG SUPPOS. ![Compare how all Medicare Part D PDP plans in WI cover MICONAZOLE 3 200MG SUPPOS..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | Q:6 /30Days |
MICROGESTIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MICROGESTIN 21 1.5-30 TAB ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN 21 1.5-30 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MICROGESTIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MICROGESTIN FE 1.5-30 TAB ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN FE 1.5-30 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MIDODRINE HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MIDODRINE HCL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIDODRINE HCL 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MINOCYCLINE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MINOCYCLINE HCL 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE HCL 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Minocycline Hydrochloride 100mg/1 50 CAPSULE in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Minocycline Hydrochloride 100mg/1 50 CAPSULE in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Minocycline Hydrochloride 100mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Minocycline Hydrochloride 100mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Minocycline Hydrochloride 75mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Minocycline Hydrochloride 75mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MINOCYCLINE HYDROCHLORIDE TABLETS 50MG ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE HYDROCHLORIDE TABLETS 50MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MINOXIDIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOXIDIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MINOXIDIL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOXIDIL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MIRTAZAPINE 15MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 15MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:90 /30Days |
Mirtazapine 15mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Mirtazapine 15mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIRTAZAPINE 30MG TABLET RAPID DISSOLVE ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 30MG TABLET RAPID DISSOLVE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:45 /30Days |
Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Mirtazapine 45mg/1 500 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:30 /30Days |
Mirtazapine 7.5mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Mirtazapine 7.5mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:180 /30Days |
MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE ORALLY DISINTEGRATING TABLETS 45MG 10 X 3 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:30 /30Days |
MIRTAZAPINE TABLET 30MG (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE TABLET 30MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:45 /30Days |
misoprostol 100 mcg tablet ![Compare how all Medicare Part D PDP plans in WI cover misoprostol 100 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
misoprostol 200 mcg tablet ![Compare how all Medicare Part D PDP plans in WI cover misoprostol 200 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MITOMYCIN 20 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover MITOMYCIN 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MITOXANTRONE INJECTION 2MG 125ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover MITOXANTRONE INJECTION 2MG 125ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
Modafinil 100 mg tablet [Provigil] ![Compare how all Medicare Part D PDP plans in WI cover Modafinil 100 mg tablet [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P Q:30 /30Days |
Modafinil 200 mg tablet [Provigil] ![Compare how all Medicare Part D PDP plans in WI cover Modafinil 200 mg tablet [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Moexipril hcl 15 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Moexipril hcl 15 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
Moexipril HCL 7.5mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Moexipril HCL 7.5mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOEXIPRIL-HYDROCHLOROTHIAZIDE 15-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOEXIPRIL-HYDROCHLOROTHIAZIDE 7.5-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$5.00 | $10.00 | None |
MOMETASONE FUROATE 0.1% OINT ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MOMETASONE FUROATE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
Mometasone Furoate 1mg/g ![Compare how all Medicare Part D PDP plans in WI cover Mometasone Furoate 1mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN ![Compare how all Medicare Part D PDP plans in WI cover MONONESSA TABLETS .250;.035MG; MG 6 X 28 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MONTELUKAST SOD 10 MG TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover MONTELUKAST SOD 10 MG TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:30 /30Days |
montelukast sod 4 mg granules [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover montelukast sod 4 mg granules [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
montelukast sod 4 mg tab chew [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover montelukast sod 4 mg tab chew [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:30 /30Days |
montelukast sod 5 mg tab chew [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover montelukast sod 5 mg tab chew [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:30 /30Days |
MORPHINE 2 MG/ML ISECURE SYR ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE 2 MG/ML ISECURE SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MORPHINE 4 MG/ML ISECURE SYR ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE 4 MG/ML ISECURE SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MORPHINE SULFATE 100MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 100MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days |
MORPHINE SULFATE 100mg/5mL 15 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 100mg/5mL 15 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:270 /30Days |
MORPHINE SULFATE 10MG/5ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 10MG/5ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:2700 /30Days |
MORPHINE SULFATE 15MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 15MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days |
MORPHINE SULFATE 15MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 15MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:360 /30Days |
MORPHINE SULFATE 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
MORPHINE SULFATE 20MG/5ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 20MG/5ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:1350 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULFATE 30MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 30MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days |
MORPHINE SULFATE 30MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 30MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:180 /30Days |
MORPHINE SULFATE TABLET ER 60MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE TABLET ER 60MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:90 /30Days |
MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover MOXEZA 5.45mg/mL 3 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
MOXIFLOXACIN HCL 400 MG TABLET [Avelox] ![Compare how all Medicare Part D PDP plans in WI cover MOXIFLOXACIN HCL 400 MG TABLET [Avelox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | Q:21 /1Days |
MOZOBIL 20 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover MOZOBIL 20 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:60 /30Days |
mupirocin 2% cream ![Compare how all Medicare Part D PDP plans in WI cover mupirocin 2% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MUPIROCIN 2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover MUPIROCIN 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$16.00 | $32.00 | None |
MUSTARGEN 10 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover MUSTARGEN 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | P |
MYCAMINE 100MG/VIAL FOR INJECTION SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MYCAMINE 100MG/VIAL FOR INJECTION SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MYCAMINE 50MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover MYCAMINE 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | None |
MYCOBUTIN 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYCOBUTIN 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MYCOPHENOLATE 200 MG/ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLATE 200 MG/ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
Mycophenolate Mofetil 250mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Mycophenolate Mofetil 250mg/1 100 BLISTER PACK in 1 BOX, UNIT-DOSE / 1 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
MYCOPHENOLATE MOFETIL TABLETS 500MG 500 BOT ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLATE MOFETIL TABLETS 500MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
MYORISAN 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MYORISAN 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MYORISAN 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $270.00 | None |
MYOZYME 50MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover MYOZYME 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5* |
Specialty Tier |
33% | N/A | P |
MYRBETRIQ ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYRBETRIQ ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |
MYRBETRIQ ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYRBETRIQ ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | Q:30 /30Days |