2017 Medicare Part D Plan Formulary Information |
MHS Health Wisconsin Medicare Advantage (HMO SNP) (H8189-001-0)
Benefit Details
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The MHS Health Wisconsin Medicare Advantage (HMO SNP) (H8189-001-0) Formulary Drugs Starting with the Letter L in Adams County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $40.00 Deductible: $400 |
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LABETALOL HCL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LABETALOL HCL 300MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LABETALOL HCL 5MG/20ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 5MG/20ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LACTATED RINGERS INJECTION ![Compare how all Medicare Part D PDP plans in WI cover LACTATED RINGERS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LACTATED RINGERS IRRIGATION 4 CONTAINER in 1 CASE / 40 ![Compare how all Medicare Part D PDP plans in WI cover LACTATED RINGERS IRRIGATION 4 CONTAINER in 1 CASE / 40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LACTULOSE SOLUTION ORAL 10GM/15ML 946ML BOT ![Compare how all Medicare Part D PDP plans in WI cover LACTULOSE SOLUTION ORAL 10GM/15ML 946ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lamivudine 10 mg/ml oral soln ![Compare how all Medicare Part D PDP plans in WI cover Lamivudine 10 mg/ml oral soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMIVUDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMIVUDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lamivudine hbv 100 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamivudine hbv 100 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMIVUDINE-ZIDOVUDINE TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE-ZIDOVUDINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMOTRIGINE 150MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 150MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMOTRIGINE 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMOTRIGINE 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMOTRIGINE 25MG TABLET DISPERSIBLE ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 25MG TABLET DISPERSIBLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LAMOTRIGINE 5MG TABLET DISPERSIBLE ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 5MG TABLET DISPERSIBLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lamotrigine ODT 100 MG Tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamotrigine ODT 100 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lamotrigine ODT 200 MG Tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamotrigine ODT 200 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lamotrigine ODT 25 MG Tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamotrigine ODT 25 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lamotrigine ODT 50 MG Tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamotrigine ODT 50 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LANOXIN 0.25 MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 0.25 MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P |
LANOXIN 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
LANOXIN 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:30 /30Days |
Lansoprazole 15mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Lansoprazole 15mg/1 30 CAPSULE, DELAYED RELEASE PELLETS in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:30 /30Days |
Lansoprazole 30mg/1 30 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Lansoprazole 30mg/1 30 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:60 /30Days |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:45 /30Days |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LARTRUVO 500 MG/50 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LARTRUVO 500 MG/50 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P Q:30 /30Days |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P Q:30 /30Days |
Latuda 40mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Latuda 40mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P Q:30 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P Q:30 /30Days |
Latuda 80mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Latuda 80mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P Q:30 /30Days |
LAZANDA 100 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover LAZANDA 100 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:30 /30Days |
LAZANDA 300 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover LAZANDA 300 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:150 /30Days |
LAZANDA 400 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover LAZANDA 400 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | P Q:30 /30Days |
LEENA 28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEENA 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEFLUNOMIDE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEFLUNOMIDE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:30 /30Days |
Leflunomide 20 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Leflunomide 20 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:90 /30Days |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:90 /30Days |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:90 /30Days |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
Lessina 3 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 Lessina 3 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) |
2 |
Generic |
$20.00 | N/A | None |
LETAIRIS 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LETAIRIS 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LETAIRIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LETAIRIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEUCOVORIN CALCIUM 100MG VL ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 100MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Leucovorin Calcium 15mg/1 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Leucovorin Calcium 15mg/1 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEUCOVORIN CALCIUM 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEUCOVORIN CALCIUM 350MG VL ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 350MG VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEUCOVORIN CALCIUM 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LEUKINE 250 MCG VIAL ![Compare how all Medicare Part D PDP plans in WI cover LEUKINE 250 MCG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Leuprolide 2wk 1 mg/0.2 ml kit ![Compare how all Medicare Part D PDP plans in WI cover Leuprolide 2wk 1 mg/0.2 ml kit.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levalbuterol 0.31 mg/3 ml sol ![Compare how all Medicare Part D PDP plans in WI cover Levalbuterol 0.31 mg/3 ml sol.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | P |
Levalbuterol 0.63 mg/3 ml sol ![Compare how all Medicare Part D PDP plans in WI cover Levalbuterol 0.63 mg/3 ml sol.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | P |
Levalbuterol conc 1.25 mg/0.5 ![Compare how all Medicare Part D PDP plans in WI cover Levalbuterol conc 1.25 mg/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex HFA] ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:45 /30Days |
LEVEMIR 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LEVEMIR 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:30 /30Days |
LEVEMIR FLEXTOUCH 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in WI cover LEVEMIR FLEXTOUCH 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:45 /30Days |
Levetiracetam 100 ML 10 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Levetiracetam 100 ML 10 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levetiracetam 100 ML 15 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Levetiracetam 100 ML 15 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levetiracetam 100 ML 5 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Levetiracetam 100 ML 5 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levetiracetam 100mg/mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Levetiracetam 100mg/mL 473 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVETIRACETAM 500 MG TABLET 120 BOT ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 500 MG TABLET 120 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levetiracetam 500 mg/5 ml vial ![Compare how all Medicare Part D PDP plans in WI cover Levetiracetam 500 mg/5 ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVETIRACETAM TABLETS 1000MG 60 BOT ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM TABLETS 1000MG 60 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVETIRACETAM TABLETS 250MG 500 BOT ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM TABLETS 250MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM TABLETS 750MG 500 BOT ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM TABLETS 750MG 500 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOCARNITINE 1 G/10 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover LEVOCARNITINE 1 G/10 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOCETIRIZINE 2.5 MG/5 ML SOL ![Compare how all Medicare Part D PDP plans in WI cover LEVOCETIRIZINE 2.5 MG/5 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOCETIRIZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOCETIRIZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:30 /30Days |
Levofloxacin 250mg/1 [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 250mg/1 [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:10 /10Days |
Levofloxacin 25mg/mL 1 BOTTLE per CARTON / 100 mL in 1 BOTTLE [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 25mg/mL 1 BOTTLE per CARTON / 100 mL in 1 BOTTLE [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levofloxacin 500 MG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 500 MG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:14 /14Days |
LEVOFLOXACIN 500 MG/20 ML VIAL [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 500 MG/20 ML VIAL [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Levofloxacin 750 MG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 750 MG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:14 /14Days |
LEVOFLOXACIN-D5W 750 MG/150 ML [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN-D5W 750 MG/150 ML [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev] ![Compare how all Medicare Part D PDP plans in WI cover LEVOLEUCOVORIN 175 MG/17.5 ML [Fusilev].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levoleucovorin 50 mg vial [Fusilev] ![Compare how all Medicare Part D PDP plans in WI cover Levoleucovorin 50 mg vial [Fusilev].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levonor-eth Estrad 0.15-0.03-0.01 ![Compare how all Medicare Part D PDP plans in WI cover Levonor-eth Estrad 0.15-0.03-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in WI cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LEVORPHANOL 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVORPHANOL 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:120 /30Days |
Levothyroxine 100 mcg tablet ![Compare how all Medicare Part D PDP plans in WI cover Levothyroxine 100 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Levothyroxine 25 mcg tablet ![Compare how all Medicare Part D PDP plans in WI cover Levothyroxine 25 mcg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 150MCG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 150MCG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 75MCG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 75MCG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
LEXIVA 700MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover LEXIVA 700MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lidocaine 2% viscous soln ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine 2% viscous soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIDOCAINE 5% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE 5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lidocaine 5% patch ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine 5% patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | P Q:90 /30Days |
lidocaine hcl 2% jelly ![Compare how all Medicare Part D PDP plans in WI cover lidocaine hcl 2% jelly.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIDOCAINE HCL 2% JELLY 30ML TUBE ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE HCL 2% JELLY 30ML TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lidocaine hcl 4% solution ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine hcl 4% solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lidocaine Hydrochloride 20mg/mL 25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine Hydrochloride 20mg/mL 25 VIAL, MULTI-DOSE in 1 TRAY / 20 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lidocaine Hydrochloride 5 ML 10 MG/ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine Hydrochloride 5 ML 10 MG/ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lidocaine Hydrochloride 5mg/mL 25 VIAL, SINGLE-DOSE in 1 CONTAINER / 50 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine Hydrochloride 5mg/mL 25 VIAL, SINGLE-DOSE in 1 CONTAINER / 50 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIDOCAINE-PRILOCAINE CREAM ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE-PRILOCAINE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LINCOCIN 300MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LINCOCIN 300MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lincomycin hcl 600 mg/2 ml vl [Lincocin] ![Compare how all Medicare Part D PDP plans in WI cover Lincomycin hcl 600 mg/2 ml vl [Lincocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Linezolid 20 MG/ML Oral Suspension [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover Linezolid 20 MG/ML Oral Suspension [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:600 /10Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:20 /10Days |
Linezolid 600 mg/300 ml iv sol [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover Linezolid 600 mg/300 ml iv sol [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
liothyronine sodium 10ug/mL 1 VIAL per CARTON / 1 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover liothyronine sodium 10ug/mL 1 VIAL per CARTON / 1 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIOTHYRONINE SODIUM TABLETS 25MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SODIUM TABLETS 25MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SODIUM TABLETS 50MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LIOTHYRONINE SODIUM TABLETS 5MCG 100 TABLETS BOT ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SODIUM TABLETS 5MCG 100 TABLETS BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LISINOPRIL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL 30MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 30MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LISINOPRIL 40MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 40MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Lisinopril 5mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Lisinopril 5mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Lisinopril with Hydrochlorothiazide 12.5; 10mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Lisinopril with Hydrochlorothiazide 12.5; 10mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Lisinopril with Hydrochlorothiazide 12.5; 20mg/1; mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Lisinopril with Hydrochlorothiazide 12.5; 20mg/1; mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
LISINOPRIL-HCTZ 20-25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL-HCTZ 20-25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | None |
Lithium Carbonate 150mg/1 100 CAPSULE BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Lithium Carbonate 150mg/1 100 CAPSULE BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lithium Carbonate 300 mg tab ![Compare how all Medicare Part D PDP plans in WI cover Lithium Carbonate 300 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LITHIUM CARBONATE 300MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE 300MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lithium Carbonate 450mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Lithium Carbonate 450mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LITHIUM CARBONATE 600 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE 600 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LITHIUM CARBONATE ER TABLET 300MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE ER TABLET 300MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LITHOBID ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LITHOBID ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
LOPERAMIDE HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LOPERAMIDE HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Lopinavir-Ritonavir 80-20mg/ml [Kaletra] ![Compare how all Medicare Part D PDP plans in WI cover Lopinavir-Ritonavir 80-20mg/ml [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:120 /30Days |
Lorazepam 1 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Lorazepam 1 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:150 /30Days |
Lorazepam 2 MG 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Lorazepam 2 MG 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | Q:150 /30Days |
Lorazepam 2mg/mL 30 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in WI cover Lorazepam 2mg/mL 30 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOSARTAN POTASSIUM 100 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOSARTAN POTASSIUM 25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOSARTAN POTASSIUM 50 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOSARTAN-HCTZ 100-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 100-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOSARTAN-HCTZ 100-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 100-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOSARTAN-HCTZ 50-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 50-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOTEMAX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover LOTEMAX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
Lovastatin 10mg 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Lovastatin 10mg 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:30 /30Days |
LOVASTATIN 40 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOVASTATIN 40 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$0.00 | N/A | Q:60 /30Days |
Low-ogestrel-28 tablet ![Compare how all Medicare Part D PDP plans in WI cover Low-ogestrel-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOXAPINE 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LOXAPINE CAPSULES 10MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE CAPSULES 10MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LOXAPINE CAPSULES 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE CAPSULES 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LOXAPINE CAPSULES 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE CAPSULES 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LUMIGAN 0.1mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER ![Compare how all Medicare Part D PDP plans in WI cover LUMIGAN 0.1mg/mL 1 BOTTLE, DROPPER per CARTON / 5 mL in 1 BOTTLE, DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
Lumizyme 5mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Lumizyme 5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LUPRON DEPOT 22.5 MG 3MO KIT [LUPRON] ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 22.5 MG 3MO KIT [LUPRON].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUPRON DEPOT-PED 11.25 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT-PED 11.25 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
LUPRON DEPOT-PED 15 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT-PED 15 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Lutera-28 tablet ![Compare how all Medicare Part D PDP plans in WI cover Lutera-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |
LYNPARZA 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYNPARZA 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | Q:480 /30Days |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:90 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:90 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:90 /30Days |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | Q:90 /30Days |
LYSODREN 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYSODREN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | N/A | None |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$20.00 | N/A | None |