2018 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 B in Jackson County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $40.00 Deductible: $405 |
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 |
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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BACLOFEN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | 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) |
3 |
Specialty Tier |
25% | N/A | S |
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) |
3 |
Specialty Tier |
25% | N/A | S |
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) |
3 |
Specialty Tier |
25% | N/A | S |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BAVENCIO 200 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BAVENCIO 200 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P |
BAXDELA 450 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BAXDELA 450 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:28 /14Days |
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) |
2 |
Brand |
$52.00 | N/A | P |
BEKYREE 28 DAY TABLET [VIORELE] ![Compare how all Medicare Part D PDP plans in WI cover BEKYREE 28 DAY TABLET [VIORELE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BELBUCA 150 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 150 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 300 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 300 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 450 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 450 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 600 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 600 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 75 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 75 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 750 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 750 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BELBUCA 900 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 900 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Specialty Tier |
25% | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | Q:30 /30Days |
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) |
2 |
Brand |
$52.00 | N/A | Q:30 /30Days |
BENAZEPRIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BENAZEPRIL HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BENAZEPRIL HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BENAZEPRIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
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* |
Generic |
$14.00 | N/A | None |
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* |
Generic |
$14.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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* |
Generic |
$14.00 | N/A | None |
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* |
Generic |
$14.00 | N/A | None |
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) |
3 |
Specialty Tier |
25% | N/A | P |
BENLYSTA 200 MG/ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
BENLYSTA 200 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
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) |
3 |
Specialty Tier |
25% | N/A | P |
BENZNIDAZOLE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | None |
BENZNIDAZOLE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | None |
BENZTROPINE MES 0.5 MG Tablet [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 0.5 MG Tablet [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1* |
Generic |
$14.00 | N/A | None |
BETAMETHASONE DP 0.05% LOT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% CRM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% LOT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
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) |
1* |
Generic |
$14.00 | N/A | None |
BETASERON 0.3 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover BETASERON 0.3 MG KIT.](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 |
BETAXOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BETAXOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
Betaxolol 5 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in WI cover Betaxolol 5 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BETHANECHOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BETHANECHOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
3 |
Specialty Tier |
25% | N/A | P |
BEVYXXA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BEVYXXA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:43 /42Days |
BEVYXXA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BEVYXXA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:43 /42Days |
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) |
3 |
Specialty Tier |
25% | N/A | P Q:420 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
2 |
Brand |
$52.00 | N/A | None |
BICALUTAMIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BICALUTAMIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | None |
BIKTARVY 50-200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIKTARVY 50-200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
BISOPROLOL FUMARATE 10 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BISOPROLOL FUMARATE 5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BISOPROLOL-HCTZ 10-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 10-6.25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BISOPROLOL-HCTZ 2.5-6.25 MG TB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 2.5-6.25 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BISOPROLOL-HCTZ 5-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 5-6.25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BLEOMYCIN SULFATE 30 UNIT VIAL ![Compare how all Medicare Part D PDP plans in WI cover BLEOMYCIN SULFATE 30 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
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) |
2 |
Brand |
$52.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | None |
Bortezomib 3.5 Mg Intravenous Solution ![Compare how all Medicare Part D PDP plans in WI cover Bortezomib 3.5 Mg Intravenous Solution.](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 |
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) |
3 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
BOSULIF 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
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) |
3 |
Specialty Tier |
25% | N/A | P Q:30 /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) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
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) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
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) |
1* |
Generic |
$14.00 | N/A | 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) |
2 |
Brand |
$52.00 | N/A | None |
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) |
2 |
Brand |
$52.00 | N/A | None |
BRIMONIDINE 0.2% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE 0.2% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
3 |
Specialty Tier |
25% | N/A | 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) |
2 |
Brand |
$52.00 | N/A | Q:600 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Specialty Tier |
25% | N/A | 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) |
3 |
Specialty Tier |
25% | N/A | 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) |
3 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
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) |
2 |
Brand |
$52.00 | N/A | Q:80 /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) |
3 |
Specialty Tier |
25% | N/A | Q:60 /30Days |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P |
BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Specialty Tier |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1* |
Generic |
$14.00 | N/A | None |
BUMETANIDE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
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* |
Generic |
$14.00 | N/A | None |
BUMETANIDE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUNAVAIL 2.1-0.3 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 2.1-0.3 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:30 /30Days |
BUNAVAIL 4.2-0.7 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 4.2-0.7 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BUNAVAIL 6.3-1 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 6.3-1 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:60 /30Days |
BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:90 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:90 /30Days |
BUPRENORPHINE 0.3 MG/ML SYRING [Buprenex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3 MG/ML SYRING [Buprenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUPRENORPHINE 0.3 MG/ML VIAL [Buprenex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3 MG/ML VIAL [Buprenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHINE 10 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 10 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 15 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 15 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 2 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 2 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:90 /30Days |
BUPRENORPHINE 20 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 20 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 8 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 8 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | Q:90 /30Days |
BUPROPION HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUPROPION HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL SR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BUSPIRONE HCL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | None |
BUSPIRONE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BUSPIRONE HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | 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) |
1* |
Generic |
$14.00 | N/A | None |
BUTALB-ACETAMIN-CAFF 50-325-40 ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-ACETAMIN-CAFF 50-325-40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
BUTALB-CAFF-ACETAMINOPH-CODEIN ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-CAFF-ACETAMINOPH-CODEIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
BUTALBITAL COMP-CODEINE #3 CAP ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL COMP-CODEINE #3 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUTALBITAL-ASA-CAFFEINE CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ASA-CAFFEINE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Generic |
$14.00 | N/A | P Q:180 /30Days |
BUTRANS 7.5 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover BUTRANS 7.5 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | Q:4 /28Days |
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) |
2 |
Brand |
$52.00 | N/A | None |
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) |
2 |
Brand |
$52.00 | N/A | None |
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) |
2 |
Brand |
$52.00 | N/A | None |
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) |
2 |
Brand |
$52.00 | N/A | None |
BYVALSON 5 MG-80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BYVALSON 5 MG-80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Brand |
$52.00 | N/A | None |