2016 Medicare Part D Plan Formulary Information |
iCare Medicare Plan (HMO SNP) (H2237-001-0)
Benefit Details
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The iCare Medicare Plan (HMO SNP) (H2237-001-0) Formulary Drugs Starting with the Letter E in Racine County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $37.70 Deductible: $360 |
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
E.E.S. 400 FILMTAB ![Compare how all Medicare Part D PDP plans in WI cover E.E.S. 400 FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
E.E.S. GRAN SUS 200/5ML ![Compare how all Medicare Part D PDP plans in WI cover E.E.S. GRAN SUS 200/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ECONAZOLE NITRATE 1% CREAM 85GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover ECONAZOLE NITRATE 1% CREAM 85GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EDURANT 27.5mg/1 ![Compare how all Medicare Part D PDP plans in WI cover EDURANT 27.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
EFFIENT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EFFIENT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:30 /30Days |
EFFIENT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EFFIENT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:30 /30Days |
ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WI cover ELAPRASE 6mg/3mL 1 VIAL, GLASS in 1 BOX / 3 mL in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ELIDEL 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover ELIDEL 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
ELIGARD 22.5 MG SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 22.5 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:1 /84Days |
ELIGARD 30 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 30 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:1 /112Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELIGARD 45 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 45 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:1 /168Days |
ELIGARD 7.5 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 7.5 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT ![Compare how all Medicare Part D PDP plans in WI cover ELIPHOS TABLETS CALCIUM ACETATE TABLETS 667MG 200 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ELIQUIS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ELIQUIS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
ELIQUIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ELIQUIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Elitek 3 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Elitek 3 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ELITEK 7.5 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ELITEK 7.5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ELMIRON 100mg GELATIN COATED 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ELMIRON 100mg GELATIN COATED 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EMCYT 140MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMCYT 140MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EMEND 150 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover EMEND 150 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:2 /28Days |
EMEND 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMEND 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMEND CAPSULES 125MG 6 BLPK ![Compare how all Medicare Part D PDP plans in WI cover EMEND CAPSULES 125MG 6 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
EMEND CAPSULES 80MG 2 BLPK ![Compare how all Medicare Part D PDP plans in WI cover EMEND CAPSULES 80MG 2 BLPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
EMEND TRIFOLD PACK ![Compare how all Medicare Part D PDP plans in WI cover EMEND TRIFOLD PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
Emoquette 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Emoquette 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EMPLICITI 300 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover EMPLICITI 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
EMPLICITI 400 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover EMPLICITI 400 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:30 /30Days |
EMTRIVA 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EMTRIVA 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EMTRIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMTRIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMVERM 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover EMVERM 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | Q:6 /21Days |
ENALAPRIL MALEATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENALAPRIL MALEATE 2.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 2.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Enalapril Maleate 20mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Enalapril Maleate 20mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENALAPRIL MALEATE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Enalapril Maleate and Hydrochlorothiazide 10; 25mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Enalapril Maleate and Hydrochlorothiazide 10; 25mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE-HCTZ 5-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENBREL 25 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
ENBREL 25MG KIT ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
ENBREL 50 MG/ML SURECLICK SYR ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50 MG/ML SURECLICK SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
ENBREL 50mg/mL ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENDOCET 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | Q:360 /30Days |
ENDOCET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | Q:360 /30Days |
ENDOCET 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | Q:360 /30Days |
ENGERIX B INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX B INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:3 /365Days |
ENGERIX-B 10MCG 10 X 0.5ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX-B 10MCG 10 X 0.5ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:3 /365Days |
ENGERIX-B 20 MCG/ML SYRN ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX-B 20 MCG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:3 /365Days |
ENOXAPARIN 100 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 100 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ENOXAPARIN 120 MG/0.8 ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 120 MG/0.8 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ENOXAPARIN 150 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 150 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ENOXAPARIN 30 MG/0.3 ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 30 MG/0.3 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENOXAPARIN 300 MG/3 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 300 MG/3 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENOXAPARIN 40 MG/0.4 ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 40 MG/0.4 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENOXAPARIN 60 MG/0.6 ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 60 MG/0.6 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENOXAPARIN 80 MG/0.8 ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 80 MG/0.8 ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENTACAPONE 200 MG TABLET [Comtan Entacapone] ![Compare how all Medicare Part D PDP plans in WI cover ENTACAPONE 200 MG TABLET [Comtan Entacapone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENTECAVIR 0.5 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in WI cover ENTECAVIR 0.5 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ENTECAVIR 1 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in WI cover ENTECAVIR 1 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ENTRESTO 24 MG-26 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 24 MG-26 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:60 /30Days |
ENTRESTO 49 MG-51 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 49 MG-51 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:60 /30Days |
ENTRESTO 97 MG-103 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 97 MG-103 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:60 /30Days |
ENULOSE 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover ENULOSE 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ENVARSUS XR 0.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENVARSUS XR 0.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENVARSUS XR 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENVARSUS XR 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
ENVARSUS XR 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENVARSUS XR 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P |
EPINASTINE HCL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover EPINASTINE HCL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Epinephrine 0.15 mg auto-injct ![Compare how all Medicare Part D PDP plans in WI cover Epinephrine 0.15 mg auto-injct.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Epinephrine 0.3 mg auto-inject ![Compare how all Medicare Part D PDP plans in WI cover Epinephrine 0.3 mg auto-inject.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EPIPEN 0.3MG AUTO-INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover EPIPEN 0.3MG AUTO-INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EPIPEN JR 0.15MG AUTO-INJCT ![Compare how all Medicare Part D PDP plans in WI cover EPIPEN JR 0.15MG AUTO-INJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EPITOL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPITOL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EPIVIR HBV 25MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR HBV 25MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Eplerenone 25mg/1 90 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Eplerenone 25mg/1 90 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Eplerenone 50mg/1 90 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Eplerenone 50mg/1 90 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPOGEN 10000U/ML VIAL MDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 10000U/ML VIAL MDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:12 /28Days |
EPOGEN 2000[iU]/mL 10 VIAL in 1 PACKAGE / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 2000[iU]/mL 10 VIAL in 1 PACKAGE / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:12 /28Days |
EPOGEN 3000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 3000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:12 /28Days |
EPOGEN 4000U/ML VIAL SDV ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN 4000U/ML VIAL SDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:12 /28Days |
EPOGEN INJECTION 20000U 10 X 1ML CRTN ![Compare how all Medicare Part D PDP plans in WI cover EPOGEN INJECTION 20000U 10 X 1ML CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | P Q:12 /28Days |
EPZICOM 600MG/300MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover EPZICOM 600MG/300MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
ERGOLOID MESYLATES TABLETS 1MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover ERGOLOID MESYLATES TABLETS 1MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERGOMAR 2 MG TABLET SL ![Compare how all Medicare Part D PDP plans in WI cover ERGOMAR 2 MG TABLET SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | Q:40 /28Days |
ERIVEDGE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ERIVEDGE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
ERRIN 0.35MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ERRIN 0.35MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERY 2% PADS 2% 60 PADS JAR ![Compare how all Medicare Part D PDP plans in WI cover ERY 2% PADS 2% 60 PADS JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB 500mg/1 100 TABLET, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERY-TAB TAB 250MG EC ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB TAB 250MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERY-TAB TAB 333MG EC ![Compare how all Medicare Part D PDP plans in WI cover ERY-TAB TAB 333MG EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
ERYTHROCIN 500MG ADDVNT VL ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROCIN 500MG ADDVNT VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
ERYTHROCIN TAB 250MG ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROCIN TAB 250MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Erythromycin 2% solution ![Compare how all Medicare Part D PDP plans in WI cover Erythromycin 2% solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Erythromycin 20mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Erythromycin 20mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERYTHROMYCIN 500 MG FILMTAB ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 500 MG FILMTAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERYTHROMYCIN EC 250 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN EC 250 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERYTHROMYCIN ES 400 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN ES 400 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN OPHTHALMIC OINTMENT 0.5% 1 G BOX OF 50 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERYTHROMYCIN TAB 250MG BS ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN TAB 250MG BS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESBRIET 267 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ESBRIET 267 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
ESCITALOPRAM 10 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 10 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESCITALOPRAM 20 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 20 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESCITALOPRAM 5 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 5 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM OXALATE 5 MG/5 ML [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESOMEPRAZOLE SODIUM 20 MG VIAL [Nexium] ![Compare how all Medicare Part D PDP plans in WI cover ESOMEPRAZOLE SODIUM 20 MG VIAL [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESOMEPRAZOLE SODIUM 40 MG VIAL [Nexium] ![Compare how all Medicare Part D PDP plans in WI cover ESOMEPRAZOLE SODIUM 40 MG VIAL [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ESTRACE VAG CREAM 0.1MG/GM ![Compare how all Medicare Part D PDP plans in WI cover ESTRACE VAG CREAM 0.1MG/GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Estradiol / Norethindrone Acetate 0.5; 0.1mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, FILM C ![Compare how all Medicare Part D PDP plans in WI cover Estradiol / Norethindrone Acetate 0.5; 0.1mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, FILM C.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
Estradiol 0.025 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.025 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Estradiol 0.0375 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.0375 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:8 /28Days |
Estradiol 0.05 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.05 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:8 /28Days |
Estradiol 0.075 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.075 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:8 /28Days |
Estradiol 0.1 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.1 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:8 /28Days |
ESTRADIOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTRADIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTRADIOL TABLET 1MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TABLET 1MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTRADIOL TDS 0.025 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.025 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.0375 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.0375 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.05 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.05 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.06 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.06 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL TDS 0.075 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.075 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
ESTRADIOL TDS 0.1 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.1 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:4 /28Days |
ESTRADIOL VALERATE 20mg/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 ESTRADIOL VALERATE 20mg/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) |
1* |
Generic |
$13.00 | $39.00 | None |
ESTRADIOL VALERATE 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 ESTRADIOL VALERATE 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) |
1* |
Generic |
$13.00 | $39.00 | None |
ESTRADIOL-NORETH 1.0-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL-NORETH 1.0-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTROPIPATE 0.625(0.75 MG) TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 0.625(0.75 MG) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTROPIPATE 1.25(1.5 MG) TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 1.25(1.5 MG) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESTROPIPATE 2.5(3 MG) TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTROPIPATE 2.5(3 MG) TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P |
ESZOPICLONE 1 MG TABLET [Lunesta] ![Compare how all Medicare Part D PDP plans in WI cover ESZOPICLONE 1 MG TABLET [Lunesta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:30 /30Days |
Eszopiclone 2 mg tablet [Lunesta] ![Compare how all Medicare Part D PDP plans in WI cover Eszopiclone 2 mg tablet [Lunesta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:30 /30Days |
Eszopiclone 3 mg tablet [Lunesta] ![Compare how all Medicare Part D PDP plans in WI cover Eszopiclone 3 mg tablet [Lunesta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETHAMBUTOL HCL 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ETHAMBUTOL HCL 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Ethambutol Hydrochloride 100mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Ethambutol Hydrochloride 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TAB 21.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETHOSUXIMIDE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ETHOSUXIMIDE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETHOSUXIMIDE 250MG/5ML SYRP ![Compare how all Medicare Part D PDP plans in WI cover ETHOSUXIMIDE 250MG/5ML SYRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETODOLAC 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Etodolac 300 mg capsule ![Compare how all Medicare Part D PDP plans in WI cover Etodolac 300 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETODOLAC 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETODOLAC 400MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 400MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETODOLAC 500MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 500MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Etodolac 500mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Etodolac 500mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETODOLAC 600MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 600MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
ETOPOPHOS 100MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ETOPOPHOS 100MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
Etoposide 500 mg/25 ml vial ![Compare how all Medicare Part D PDP plans in WI cover Etoposide 500 mg/25 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EVOTAZ 300 MG-150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EVOTAZ 300 MG-150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
Exemestane 25mg/1 30 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Exemestane 25mg/1 30 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$13.00 | $39.00 | None |
EXJADE 125MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 125MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$44.00 | $132.00 | None |
EXJADE 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
EXJADE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EXJADE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
EXTAVIA 15 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover EXTAVIA 15 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | S |