2016 Medicare Part D Plan Formulary Information |
UnitedHealthcare Assisted Living Plan (HMO-POS SNP) (H5253-064-0)
Benefit Details
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The UnitedHealthcare Assisted Living Plan (HMO-POS SNP) (H5253-064-0) Formulary Drugs Starting with the Letter B in Brown County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $23.80 Deductible: $60 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in WI cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BACLOFEN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BACLOFEN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in WI cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BANZEL TABLET 400MG ![Compare how all Medicare Part D PDP plans in WI cover BANZEL TABLET 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BEKYREE 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in WI cover BEKYREE 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BELEODAQ 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BELEODAQ 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BELSOMRA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BELSOMRA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BELSOMRA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BELSOMRA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BENAZEPRIL HCL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
BENAZEPRIL HCL 20mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 20mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
BENAZEPRIL HCL 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
BENAZEPRIL HCL 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:60 /30Days |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
BENICAR 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BENICAR 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENICAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
BENICAR HCT 20-12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 20-12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BENICAR HCT 40-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 40-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BENICAR HCT TABLET 12.5-40MG (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT TABLET 12.5-40MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BENLYSTA 400 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 400 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BENZTROPINE 2 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE 2 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BENZTROPINE MESYLATE 0.5 MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MESYLATE 0.5 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Benztropine Mesylate 1mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Benztropine Mesylate 1mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BENZTROPINE MESYLATE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MESYLATE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in WI cover BERINERT 500 UNIT KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in WI cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Betamethasone Dipropionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.60mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.64mg/mL 60 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Betamethasone DP 0.05% ointment ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone DP 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BETAMETHASONE DP AUG 0.05% OIN ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% OIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BETAMETHASONE VALERATE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BETAMETHASONE VALERATE CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM ![Compare how all Medicare Part D PDP plans in WI cover BETASERON KIT 0.3MG/VIAL 14 TRAY BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
Betaxolol 10mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Betaxolol 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Betaxolol 20mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Betaxolol 20mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Betaxolol hcl 0.5% eye drop ![Compare how all Medicare Part D PDP plans in WI cover Betaxolol hcl 0.5% eye drop.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Bethanechol 10 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Bethanechol 10 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Bethanechol 5 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Bethanechol 5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BETHANECHOL CHLORIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BETHANECHOL CHLORIDE 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL CHLORIDE 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BETHKIS 300 MG/4 ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover BETHKIS 300 MG/4 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BETIMOL 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in WI cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Bicalutamide 50mL/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Bicalutamide 50mL/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in WI cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BICNU 100 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BICNU 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BIDIL TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIDIL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BINOSTO 70 MG TABLET EFF ![Compare how all Medicare Part D PDP plans in WI cover BINOSTO 70 MG TABLET EFF.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:4 /28Days |
BISOPROLOL FUMARATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BISOPROLOL FUMARATE 5MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 5MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 10-6.25MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 2.5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
BIVIGAM LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in WI cover BIVIGAM LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BLEOMYCIN SULFATE 30UNITS VIA ![Compare how all Medicare Part D PDP plans in WI cover BLEOMYCIN SULFATE 30UNITS VIA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BLEPHAMIDE 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BLISOVI 24 FE TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI 24 FE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BLISOVI FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BLISOVI FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BONIVA 3mg/3mL SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 3mg/3mL SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | P |
BOTOX 100UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOTOX 100UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P Q:9 /30Days |
BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P Q:9 /30Days |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
Brimonidine Tartrate 1.5mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Brimonidine Tartrate 1.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION 0.2% 10ML BOTPL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:60 /30Days |
BRIVIACT 10 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:600 /30Days |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:60 /30Days |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:60 /30Days |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRIVIACT 50 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 50 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:600 /30Days |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | Q:60 /30Days |
Bromocriptine mesylate 2.5mg/1 24 BOTTLE per CARTON / 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bromocriptine mesylate 2.5mg/1 24 BOTTLE per CARTON / 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE MESYLATE 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in WI cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BUDESONIDE 0.25 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.25 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.5 MG/2 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
BUDESONIDE 1 MG/2 ML INH SUSP ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 1 MG/2 ML INH SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P |
Budesonide 3mg 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Budesonide 3mg 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BUMETANIDE 0.5 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.5 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUMETANIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BUMETANIDE 2 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 2 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BUPHENYL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
BUPRENORPHINE 0.3MG/ML SYRN ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3MG/ML SYRN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | None |
Buprenorphine HCl 2mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Buprenorphine HCl 2mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:90 /30Days |
Buprenorphine HCl 8mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Buprenorphine HCl 8mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:90 /30Days |
BUPRENORPHINE-NALOXONE 2-0.5 MG SL ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE-NALOXONE 2-0.5 MG SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P Q:90 /30Days |
BUPRENORPHINE-NALOXONE 8-2 MG SL ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE-NALOXONE 8-2 MG SL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | P Q:90 /30Days |
BUPROBAN ER 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROBAN ER 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL SR 200MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 200MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Bupropion Hydrochloride 100mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bupropion Hydrochloride 100mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Bupropion Hydrochloride 150mg/1 100 TABLET, ER in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bupropion Hydrochloride 150mg/1 100 TABLET, ER in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUPROPION HYDROCHLORIDE 75mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HYDROCHLORIDE 75mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUSPIRONE HCL 15MG TABLET (180 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 15MG TABLET (180 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUSPIRONE HCL 30MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 30MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUSPIRONE HCL 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HYDROCHLORIDE 10 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUSULFEX 6mg/mL ![Compare how all Medicare Part D PDP plans in WI cover BUSULFEX 6mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
31% | 31% | None |
Butorphanol 1 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Butorphanol 1 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:5 /30Days |
Butorphanol 2 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Butorphanol 2 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | None |
BYDUREON 2 MG PEN INJECT ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON 2 MG PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /28Days |
BYDUREON 2 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON 2 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:4 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:2 /30Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $290.00 | Q:1 /30Days |
Bystolic 10mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 10mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
Bystolic 2.5mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 2.5mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |
BYSTOLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BYSTOLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bystolic 5mg 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 5mg 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$47.00 | $131.00 | Q:30 /30Days |