2018 Medicare Part D Plan Formulary Information |
Anthem MediBlue Access (PPO) (H4036-008-0)
Benefit Details
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The Anthem MediBlue Access (PPO) (H4036-008-0) Formulary Drugs Starting with the Letter C in Brown County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $37.00 Deductible: $0 |
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CABOMETYX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
CABOMETYX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
CABOMETYX 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
CALAN 120MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CALAN 120MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CALAN SR 120MG CAPLET SA ![Compare how all Medicare Part D PDP plans in WI cover CALAN SR 120MG CAPLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CALCIPOTRIENE 0.005% CREAM ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE 0.005% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
CALCIPOTRIENE 0.005% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE 0.005% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:60 /30Days |
Calcipotriene 50ug/g 60 g per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Calcipotriene 50ug/g 60 g per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in WI cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:4 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Calcitriol 1 MCG per 1 ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Calcitriol 1 MCG per 1 ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CALCITRIOL 1MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 1MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
CALCITRIOL 3 MCG/G OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 3 MCG/G OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CALCIUM ACETATE CAPSULE 667 MG ![Compare how all Medicare Part D PDP plans in WI cover CALCIUM ACETATE CAPSULE 667 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Calcium Chloride 0.002 MEQ/ML / Potassium Chloride 0.004 MEQ/ML / Sodium Chloride 0.147 MEQ/ML Injec ![Compare how all Medicare Part D PDP plans in WI cover Calcium Chloride 0.002 MEQ/ML / Potassium Chloride 0.004 MEQ/ML / Sodium Chloride 0.147 MEQ/ML Injec.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CALQUENCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CALQUENCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CAMILA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAMILA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CANASA 1,000 MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in WI cover CANASA 1,000 MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
CANCIDAS IV 50MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CANCIDAS IV 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CANCIDAS IV 70MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CANCIDAS IV 70MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CANDESARTAN CILEXETIL 16 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 16 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CANDESARTAN CILEXETIL 32 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 32 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CANDESARTAN CILEXETIL 4 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 4 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CANDESARTAN CILEXETIL 8 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 8 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
candesartan-hctz 16-12.5 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover candesartan-hctz 16-12.5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
candesartan-hctz 32-12.5 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover candesartan-hctz 32-12.5 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CANDESARTAN-HCTZ 32-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN-HCTZ 32-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in WI cover CAPASTAT SULFATE 1g/1 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CAPRELSA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
CAPRELSA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CAPTOPRIL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in WI cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAGLU 200 MG DISPER TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAGLU 200 MG DISPER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CARBAMAZEPINE 100 MG TAB CHEW ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 100 MG TAB CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBAMAZEPINE ER 100 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 100 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE ER 200 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 200 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE ER 300 MG CAP CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 300 MG CAP CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE XR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBAMAZEPINE XR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVO ER 25-100 TAB ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVO ER 25-100 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBIDOPA-LEVO ER 50-200 TAB ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVO ER 50-200 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBIDOPA-LEVODOPA 10-100 TAB ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 10-100 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBIDOPA-LEVODOPA 25-100 TAB ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 25-100 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBIDOPA-LEVODOPA 25-250 TAB ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 25-250 TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTA 150 MG ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTA 150 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTA 75 MG ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTA 75 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 100 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTACAPONE 100 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 125 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTACAPONE 125 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 200 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTACAPONE 200 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Carboplatin 10 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in WI cover Carboplatin 10 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CARDIZEM LA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARDIZEM LA 180 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARDIZEM LA 240 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 240 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARDIZEM LA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARDIZEM LA 360 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 360 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARDIZEM LA 420 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARDIZEM LA 420 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CARISOPRODOL 350 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARISOPRODOL 350 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
CARTEOLOL HCL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover CARTEOLOL HCL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARTIA XT 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CARVEDILOL 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CARVEDILOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CARVEDILOL 3.125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 3.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CARVEDILOL 6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CAYSTON KIT 75 MG/VIAL ![Compare how all Medicare Part D PDP plans in WI cover CAYSTON KIT 75 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CAZIANT 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAZIANT 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFACLOR 125 MG/5 ML SUSP Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 125 MG/5 ML SUSP Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEFACLOR 250 MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 250 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFACLOR 250 MG/5 ML SUSPEN Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 250 MG/5 ML SUSPEN Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR 375 MG/5 ML SUSPEN Oral Suspension [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 375 MG/5 ML SUSPEN Oral Suspension [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEFACLOR 500 MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 500 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFACLOR ER 500MG TABLET SR 12HR ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR ER 500MG TABLET SR 12HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFADROXIL 1 GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 1 GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFADROXIL 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFADROXIL 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEFADROXIL 500 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 500 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFAZOLIN 1 GM VIAL 25/Box ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 1 GM VIAL 25/Box.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFAZOLIN 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFDINIR 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFDINIR 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEFEPIME HCL 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME HCL 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFEPIME HCL 2 GRAM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME HCL 2 GRAM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Cefotaxime 500 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Cefotaxime 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Cefotaxime sodium 1 gm vial ![Compare how all Medicare Part D PDP plans in WI cover Cefotaxime sodium 1 gm vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Cefotaxime sodium 2 gm vial ![Compare how all Medicare Part D PDP plans in WI cover Cefotaxime sodium 2 gm vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFOTETAN 1GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in WI cover CEFOTETAN 1GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFOTETAN 2GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in WI cover CEFOTETAN 2GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFOXITIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFOXITIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFOXITIN 2 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 2 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFPODOXIME 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFPODOXIME 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFPODOXIME 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFPODOXIME 50 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 50 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFPROZIL 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFPROZIL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEFPROZIL 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFPROZIL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFTAZIDIME 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFTRIAXONE 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFTRIAXONE 10 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFTRIAXONE 2 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 2 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFTRIAXONE 250 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 250 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CEFTRIAXONE 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 1.5 GM/VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFUROXIME 750 MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 750 MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Cefuroxime 95 MG/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in WI cover Cefuroxime 95 MG/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEFUROXIME AXETIL 250 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME AXETIL 250 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CEFUROXIME AXETIL 500 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME AXETIL 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
CELLCEPT IV INJ 500 MG ![Compare how all Medicare Part D PDP plans in WI cover CELLCEPT IV INJ 500 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CELONTIN 300 MG KAPSEAL ![Compare how all Medicare Part D PDP plans in WI cover CELONTIN 300 MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CEPHALEXIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CEPHALEXIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CEPHALEXIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CEPHALEXIN 250 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEPHALEXIN 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEPHALEXIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CEREZYME 400 UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEREZYME 400 UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CETIRIZINE HCL 1 MG/ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover CETIRIZINE HCL 1 MG/ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CEVIMELINE HCL 30 MG CAPSULE [Evoxac] ![Compare how all Medicare Part D PDP plans in WI cover CEVIMELINE HCL 30 MG CAPSULE [Evoxac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CHANTIX 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:60 /30Days |
CHANTIX 1 MG CONT MONTH BOX ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 MG CONT MONTH BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:56 /28Days |
CHANTIX 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:60 /30Days |
CHANTIX STARTING MONTH BOX ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX STARTING MONTH BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:106 /365Days |
CHLORAMPHEN NA SUCC 1GM VL ![Compare how all Medicare Part D PDP plans in WI cover CHLORAMPHEN NA SUCC 1GM VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CHLORDIAZEPOXIDE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
CHLORDIAZEPOXIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORDIAZEPOXIDE 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
CHLORHEXIDINE GLUCONATE 0.12% RINSE ![Compare how all Medicare Part D PDP plans in WI cover CHLORHEXIDINE GLUCONATE 0.12% RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CHLOROQUINE PH 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PH 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHLOROQUINE PH 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PH 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHLOROTHIAZIDE 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROTHIAZIDE 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
Chlorothiazide 500 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Chlorothiazide 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Chlorothiazide 500mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Chlorothiazide 500mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHLORPROMAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CHLORPROMAZINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CHLORPROMAZINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CHLORPROMAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 25 MG/ML AMP ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 25 MG/ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CHLORPROMAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CHLORTHALIDONE 25 MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 25 MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHLORTHALIDONE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHOLESTYRAMINE LIGHT POWDER ![Compare how all Medicare Part D PDP plans in WI cover CHOLESTYRAMINE LIGHT POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CHOLESTYRAMINE PACKET ![Compare how all Medicare Part D PDP plans in WI cover CHOLESTYRAMINE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CICLOPIROX 0.77% CREAM ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CICLOPIROX 0.77% GEL ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CICLOPIROX 0.77% TOPICAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% TOPICAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CICLOPIROX 1% SHAMPOO ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 1% SHAMPOO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CICLOPIROX 8% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 8% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIDOFOVIR 375 MG/5 ML VIAL [Vistide] ![Compare how all Medicare Part D PDP plans in WI cover CIDOFOVIR 375 MG/5 ML VIAL [Vistide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Cilastatin 250 MG / Imipenem 250 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Cilastatin 250 MG / Imipenem 250 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cilastatin 500 MG / Imipenem 500 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Cilastatin 500 MG / Imipenem 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CILOSTAZOL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CILOSTAZOL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CILOSTAZOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CILOSTAZOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 200mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cimetidine 300 MG Oral Tablet ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 300 MG Oral Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cimetidine 400mg/1 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 400mg/1 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine 800mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Cimetidine Hydrochloride Oral Solution 300mg/5mL 237 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CIPROFLOXACIN 0.3% EYE DROP [Ciloxan] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 0.3% EYE DROP [Ciloxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CIPROFLOXACIN 250 MG TABLET (100 CT) [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 250 MG TABLET (100 CT) [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CIPROFLOXACIN 250 MG/5 ML SUSP MC REC [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 250 MG/5 ML SUSP MC REC [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CIPROFLOXACIN 500 MG/5 ML SUSP MC REC [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 500 MG/5 ML SUSP MC REC [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CIPROFLOXACIN ER 1,000 MG TAB TBMP 24HR [Cipro XR] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN ER 1,000 MG TAB TBMP 24HR [Cipro XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CIPROFLOXACIN ER 500 MG TABLET TBMP 24HR [Proquin XR] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN ER 500 MG TABLET TBMP 24HR [Proquin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CIPROFLOXACIN HCL 100 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 100 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CIPROFLOXACIN HCL 500 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 500 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CIPROFLOXACIN HCL 750 MG Tablet [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 750 MG Tablet [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CISPLATIN 50MG/50ML MDV ![Compare how all Medicare Part D PDP plans in WI cover CISPLATIN 50MG/50ML MDV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CITALOPRAM HBR 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | Q:120 /30Days |
CITALOPRAM HBR 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:600 /30Days |
CITALOPRAM HBR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | Q:60 /30Days |
CITALOPRAM HBR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | Q:30 /30Days |
Cladribine 1 MG/ML in 10 ML Injection ![Compare how all Medicare Part D PDP plans in WI cover Cladribine 1 MG/ML in 10 ML Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CLARAVIS 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLARAVIS 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLARAVIS 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLARITHROMYCIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLARITHROMYCIN ER 500 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN ER 500 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Clemastine fum 2.68 mg tab ![Compare how all Medicare Part D PDP plans in WI cover Clemastine fum 2.68 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | P |
CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin] ![Compare how all Medicare Part D PDP plans in WI cover CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Clindamycin 150 MG/ML 2ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin 150 MG/ML 2ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLINDAMYCIN HCL 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLINDAMYCIN HCL 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLINDAMYCIN PH 1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PH 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PH 600 MG/4 ML VL ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PH 600 MG/4 ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLINDAMYCIN PHOSP 1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSP 1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Clindamycin Phosphate and Benzoyl Peroxide 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin Phosphate and Benzoyl Peroxide 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLINDAMYCIN PHOSPHATE VAGINAL CREAM ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE VAGINAL CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Clindamycin-d5w 300 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 300 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Clindamycin-d5w 600 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 600 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Clindamycin-d5w 900 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 900 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLINIMIX 2.75%/5% INJECTION 1000ML BAG ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 2.75%/5% INJECTION 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX 4.25%-25% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 4.25%-25% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 5/25 SULFITE FREE INJECTIONS 1035MG-420MEQ 1000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX 5%-15% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 5%-15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 2.75/10 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 2.75/10 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 4.25%-25% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 4.25%-25% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 5/25 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 5/25 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLINIMIX E 5%/15% INJECTION 2000ML BAG ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 5%/15% INJECTION 2000ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLOBETASOL 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBETASOL 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLOBETASOL 0.05% TOPICAL LOTN ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% TOPICAL LOTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLOBETASOL EMOLLIENT 0.05% CRM ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL EMOLLIENT 0.05% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
Clobetasol Propionate 0.5 MG/ML Medicated Shampoo ![Compare how all Medicare Part D PDP plans in WI cover Clobetasol Propionate 0.5 MG/ML Medicated Shampoo.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Clobetasol Propionate 0.5mg/g 1 CAN per CARTON / 100 g in 1 CAN ![Compare how all Medicare Part D PDP plans in WI cover Clobetasol Propionate 0.5mg/g 1 CAN per CARTON / 100 g in 1 CAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:100 /30Days |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLOBEX 0.05% TOPICAL LOTION ![Compare how all Medicare Part D PDP plans in WI cover CLOBEX 0.05% TOPICAL LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLOFARABINE 20 MG/20 ML VIAL [Clolar] ![Compare how all Medicare Part D PDP plans in WI cover CLOFARABINE 20 MG/20 ML VIAL [Clolar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
CLOLAR 20 MG/20 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CLOLAR 20 MG/20 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CLOMIPRAMINE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLOMIPRAMINE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CLONAZEPAM 0.125 MG DIS TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.125 MG DIS TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:4800 /30Days |
CLONAZEPAM 0.25 MG ODT TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.25 MG ODT TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:2400 /30Days |
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:1200 /30Days |
CLONAZEPAM 0.5 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.5 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:1200 /30Days |
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:600 /30Days |
CLONAZEPAM 1 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 1 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:600 /30Days |
CLONAZEPAM 2 MG ODT TAB RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 2 MG ODT TAB RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:300 /30Days |
CLONAZEPAM 2 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 2 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:300 /30Days |
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:4 /28Days |
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:4 /28Days |
CLONIDINE HCL 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CLONIDINE HCL 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CLONIDINE HCL 0.3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | N/A | None |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in WI cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:30 /30Days |
CLORAZEPATE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLORAZEPATE 3.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 3.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLORAZEPATE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLOTRIMAZOLE 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLOTRIMAZOLE 1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CLOTRIMAZOLE 10 MG TROCHE ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 10 MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE-BETAMETHASONE LOT ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE-BETAMETHASONE LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CLOZAPINE 100 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 100 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:270 /30Days |
CLOZAPINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:120 /30Days |
CLOZAPINE 25 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 25 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:1080 /30Days |
CLOZAPINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | Q:540 /30Days |
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:270 /30Days |
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:2160 /30Days |
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:180 /30Days |
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:120 /30Days |
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:1080 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COARTEM 20MG-120MG ![Compare how all Medicare Part D PDP plans in WI cover COARTEM 20MG-120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COLCRYS 0.6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COLCRYS 0.6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
COLESEVELAM 625 MG TABLET [WelChol] ![Compare how all Medicare Part D PDP plans in WI cover COLESEVELAM 625 MG TABLET [WelChol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
COLESTIPOL HCL 1G TABLET ![Compare how all Medicare Part D PDP plans in WI cover COLESTIPOL HCL 1G TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
COLESTIPOL HCL GRANULES PACKET ![Compare how all Medicare Part D PDP plans in WI cover COLESTIPOL HCL GRANULES PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
COLISTIMETHATE 150 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover COLISTIMETHATE 150 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COLY-MYCIN S OTIC SUSP DROP ![Compare how all Medicare Part D PDP plans in WI cover COLY-MYCIN S OTIC SUSP DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COMBIGAN 0.2%-0.5% DROPS ![Compare how all Medicare Part D PDP plans in WI cover COMBIGAN 0.2%-0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
COMBIVENT RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover COMBIVENT RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:8 /30Days |
COMETRIQ 100 MG DAILY-DOSE PK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 100 MG DAILY-DOSE PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:56 /28Days |
COMETRIQ 140 MG DAILY-DOSE PK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 140 MG DAILY-DOSE PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:112 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COMETRIQ 60 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 60 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:84 /28Days |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in WI cover COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in WI cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CONSTULOSE 10 GM/15 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover CONSTULOSE 10 GM/15 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN ![Compare how all Medicare Part D PDP plans in WI cover COPAXONE 20MG/ML 30 BLISTER PACK IN 1 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
COPAXONE 40 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover COPAXONE 40 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:12 /28Days |
CORLANOR 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CORLANOR 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:60 /30Days |
CORLANOR 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CORLANOR 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P Q:60 /30Days |
Cortisone 25 MG Tablet ![Compare how all Medicare Part D PDP plans in WI cover Cortisone 25 MG Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CORZIDE 40-5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CORZIDE 40-5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COSMEGEN 0.5 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover COSMEGEN 0.5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COSOPT EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover COSOPT EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COTELLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COTELLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:90 /30Days |
COUMADIN 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 3mg/1 1 BOTTLE per CARTON / 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 3mg/1 1 BOTTLE per CARTON / 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 4mg/1 1 BOTTLE in 1 CARTON / 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 4mg/1 1 BOTTLE in 1 CARTON / 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 6MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COUMADIN 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COUMADIN 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COZAAR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COZAAR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COZAAR 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COZAAR 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
COZAAR 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COZAAR 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CREON DR 36,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CREON DR 36,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CRESTOR 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CRESTOR 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CRESTOR 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CRESTOR 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CRESTOR 40mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover CRESTOR 40mg/1 30 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CRESTOR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CRESTOR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:360 /30Days |
CRIXIVAN 400mg, 180 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 400mg, 180 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | Q:180 /30Days |
CROMOLYN 20 MG/2 ML NEB SOLN ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN 20 MG/2 ML NEB SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | P Q:240 /30Days |
CROMOLYN SODIUM 100 MG/5 ML ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN SODIUM 100 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CROMOLYN SODIUM 4% 40MG 10ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN SODIUM 4% 40MG 10ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | None |
CUBICIN 500MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CUBICIN 500MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Cyclafem 1/35 6 BLISTER PACK per CARTON / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CYCLAFEM 7-7-7-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLAFEM 7-7-7-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CYCLOBENZAPRINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | P |
CYCLOBENZAPRINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOBENZAPRINE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOPHOSPHAMIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSET 0.8MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSET 0.8MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | S Q:180 /30Days |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
Cyclosporine 50 mg/ml vial ![Compare how all Medicare Part D PDP plans in WI cover Cyclosporine 50 mg/ml vial.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSPORINE MODIFIED 100 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 100 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSPORINE MODIFIED 25 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSPORINE MODIFIED 50 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYPROHEPTADINE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P |
CYRAMZA 100 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CYRAMZA 100 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CYRAMZA 500 MG/50 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CYRAMZA 500 MG/50 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
CYSTADANE 1 GRAM/1.7 ML POWDER ![Compare how all Medicare Part D PDP plans in WI cover CYSTADANE 1 GRAM/1.7 ML POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
CYSTAGON 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYSTAGON 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CYSTAGON 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYSTAGON 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
CYSTARAN 0.44% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover CYSTARAN 0.44% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
CYTARABINE 20MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover CYTARABINE 20MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover CYTARABINE SOLUTION INJECTION 100MG 20ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | P |
CYTOMEL 25MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYTOMEL 25MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYTOMEL 50MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYTOMEL 50MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |
CYTOMEL 5MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYTOMEL 5MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | N/A | None |