2018 Medicare Part D Plan Formulary Information |
Network PlatinumChoice (PPO) (H5215-011-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Network PlatinumChoice (PPO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The Network PlatinumChoice (PPO) (H5215-011-0) Formulary Drugs Starting with the Letter B in Green Lake County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $22.00 Deductible: $260 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BACiiM 500001/1 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in WI cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BACITRACIN INJ 50000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN INJ 50000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BACLOFEN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BACLOFEN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BACLOFEN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BACTRIM 400-80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM 400-80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BACTRIM DS 800-160 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM DS 800-160 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BACTROBAN 2% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN 2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BACTROBAN NASAL 2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BACTROBAN NASAL 2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT) ![Compare how all Medicare Part D PDP plans in WI cover BALSALAZIDE DISODIUM 750MG CAPSULE (280 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Balziva 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BANZEL TABLET 400MG ![Compare how all Medicare Part D PDP plans in WI cover BANZEL TABLET 400MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BASAGLAR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover BASAGLAR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BAVENCIO 200 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BAVENCIO 200 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BAXDELA 300 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BAXDELA 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BAXDELA 450 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BAXDELA 450 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BECONASE AQ 0.042% SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BECONASE AQ 0.042% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S Q:50 /30Days |
BEKYREE 28 DAY TABLET [VIORELE] ![Compare how all Medicare Part D PDP plans in WI cover BEKYREE 28 DAY TABLET [VIORELE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BELBUCA 150 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 150 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BELBUCA 300 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 300 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BELBUCA 450 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 450 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BELBUCA 600 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 600 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BELBUCA 75 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 75 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BELBUCA 750 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 750 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BELBUCA 900 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 900 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:60 /30Days |
BELEODAQ 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BELEODAQ 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BELSOMRA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BELSOMRA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BELSOMRA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BELSOMRA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BENAZEPRIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | N/A | None |
BENAZEPRIL HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | N/A | None |
BENAZEPRIL HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | N/A | None |
BENAZEPRIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | N/A | None |
BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 10-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-12.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 20-25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL-HCTZ TABLET 5-6.25MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENICAR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENICAR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENICAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENICAR HCT 20-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 20-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENICAR HCT 40-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 40-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENICAR HCT TABLET 12.5-40MG (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT TABLET 12.5-40MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 120mg/1.5mL 1 VIAL per CARTON / 1.5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BENLYSTA 200 MG/ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENLYSTA 200 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BENLYSTA 400 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 400 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BENTYL INJECTION 20MG/2ML AMP ![Compare how all Medicare Part D PDP plans in WI cover BENTYL INJECTION 20MG/2ML AMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENZACLIN GEL 50G PUMP ![Compare how all Medicare Part D PDP plans in WI cover BENZACLIN GEL 50G PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENZAMYCIN GEL ![Compare how all Medicare Part D PDP plans in WI cover BENZAMYCIN GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BENZNIDAZOLE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BENZNIDAZOLE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BENZTROPINE 2 MG/2 ML AMPULE [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE 2 MG/2 ML AMPULE [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENZTROPINE MES 0.5 MG Tablet [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 0.5 MG Tablet [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in WI cover BERINERT 500 UNIT KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in WI cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BETAGAN 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETAGAN 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE DP 0.05% LOT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Betamethasone DP 0.05% ointment ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone DP 0.05% ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% CRM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% CRM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% LOT ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE DP AUG 0.05% OIN ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% OIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE VA 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE VALERATE 0.1% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE 0.1% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAMETHASONE VALERATE 0.12% FOAM ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE 0.12% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BETAMETHASONE VALERATE OINTMENT USP ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALERATE OINTMENT USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAPACE AF 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BETAPACE AF 160 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 160 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BETAPACE AF 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BETASERON 0.3 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover BETASERON 0.3 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BETAXOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETAXOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Betaxolol 5 MG/ML Ophthalmic Solution ![Compare how all Medicare Part D PDP plans in WI cover Betaxolol 5 MG/ML Ophthalmic Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETHANECHOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETHANECHOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETHANECHOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETHANECHOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BETHKIS 300 MG/4 ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover BETHKIS 300 MG/4 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P Q:224 /28Days |
BETIMOL 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in WI cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BEVESPI AEROSPHERE INHALER ![Compare how all Medicare Part D PDP plans in WI cover BEVESPI AEROSPHERE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:21 /30Days |
BEVYXXA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BEVYXXA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BEVYXXA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BEVYXXA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in WI cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
Beyaz 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Beyaz 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICALUTAMIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BICALUTAMIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in WI cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICILLIN C-R 1.2MM UNITS SYR 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 1.2MM UNITS SYR 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BICNU 100 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BICNU 100 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BIDIL TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIDIL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BIKTARVY 50-200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIKTARVY 50-200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BIMATOPROST 0.03% EYE DROPS [Lumigan] ![Compare how all Medicare Part D PDP plans in WI cover BIMATOPROST 0.03% EYE DROPS [Lumigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | S |
BINOSTO 70 MG TABLET EFF ![Compare how all Medicare Part D PDP plans in WI cover BINOSTO 70 MG TABLET EFF.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S Q:5 /30Days |
BISOPROLOL FUMARATE 10 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BISOPROLOL FUMARATE 5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BISOPROLOL-HCTZ 10-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 10-6.25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BISOPROLOL-HCTZ 2.5-6.25 MG TB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 2.5-6.25 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BISOPROLOL-HCTZ 5-6.25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 5-6.25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BIVIGAM LIQUID 10% VIAL ![Compare how all Medicare Part D PDP plans in WI cover BIVIGAM LIQUID 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BLEOMYCIN SULFATE 30 UNIT VIAL ![Compare how all Medicare Part D PDP plans in WI cover BLEOMYCIN SULFATE 30 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BLEPHAMIDE 10-0.2% EYE OINT ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 10-0.2% EYE OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BLEPHAMIDE EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BLISOVI 24 FE TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI 24 FE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BLISOVI FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BLISOVI FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BONIVA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S Q:1 /30Days |
BONIVA 3mg/3mL SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 3mg/3mL SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BONJESTA ER 20-20 MG TABLET IR DR ![Compare how all Medicare Part D PDP plans in WI cover BONJESTA ER 20-20 MG TABLET IR DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 |
Bortezomib 3.5 Mg Intravenous Solution ![Compare how all Medicare Part D PDP plans in WI cover Bortezomib 3.5 Mg Intravenous Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BOSULIF 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BOTOX 100UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOTOX 100UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | P |
BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOTOX 200[USP'U]/1 1 VIAL in 1 CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | P |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:60 /30Days |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:60 /30Days |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | None |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
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 |
BRIMONIDINE 0.2% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE 0.2% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BRIMONIDINE TARTRATE 0.15% DRP ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE TARTRATE 0.15% DRP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BRISDELLE 7.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BRISDELLE 7.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BRIVIACT 10 MG/ML ORAL SOLN ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG/ML ORAL SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BRIVIACT 50 MG/5 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 50 MG/5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | S |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | S |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE MESYLATE 5MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in WI cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | P Q:120 /30Days |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | P |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | P |
BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE EC 3 MG CAPSULE CAPDR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE ER 9 MG TABLET DR - ER [UCERIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BUMETANIDE 0.25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUMETANIDE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUMETANIDE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUMETANIDE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUNAVAIL 2.1-0.3 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 2.1-0.3 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:30 /30Days |
BUNAVAIL 4.2-0.7 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 4.2-0.7 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BUNAVAIL 6.3-1 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover BUNAVAIL 6.3-1 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:60 /30Days |
BUPAP 50 MG-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPAP 50 MG-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:360 /30Days |
BUPHENYL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BUPRENEX 0.3 MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover BUPRENEX 0.3 MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:266 /30Days |
BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHIN-NALOXON 2-0.5 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:360 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHIN-NALOXON 8-2 MG SL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:90 /30Days |
BUPRENORPHINE 0.3 MG/ML SYRING [Buprenex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3 MG/ML SYRING [Buprenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:266 /30Days |
BUPRENORPHINE 0.3 MG/ML VIAL [Buprenex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 0.3 MG/ML VIAL [Buprenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:266 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHINE 10 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 10 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 15 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 15 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 2 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 2 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPRENORPHINE 20 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 20 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:4 /28Days |
BUPRENORPHINE 8 MG TABLET Subligual [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 8 MG TABLET Subligual [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL SR 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL SR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUSPIRONE HCL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUSPIRONE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUSPIRONE HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HYDROCHLORIDE 10 MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | None |
Busulfan 60 mg/10 ml vial [Busulfex] ![Compare how all Medicare Part D PDP plans in WI cover Busulfan 60 mg/10 ml vial [Busulfex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | None |
BUSULFEX 6mg/mL ![Compare how all Medicare Part D PDP plans in WI cover BUSULFEX 6mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
27% | N/A | P |
BUTALB-ACETAMIN-CAFF 50-325-40 ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-ACETAMIN-CAFF 50-325-40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUTALB-CAFF-ACETAMINOPH-CODEIN ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-CAFF-ACETAMINOPH-CODEIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL COMP-CODEINE #3 CAP ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL COMP-CODEINE #3 CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL-ASA-CAFFEINE CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ASA-CAFFEINE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN 50-300 tab ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN 50-300 tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40 ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE 50-300-40.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | Q:360 /30Days |
Butisol Sodium 30mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Butisol Sodium 30mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BUTORPHANOL 10MG/ML SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 10MG/ML SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:5 /28Days |
BUTORPHANOL 1MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 1MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:857 /30Days |
BUTORPHANOL 2MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 2MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | N/A | Q:428 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Butrans 10ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 10ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:4 /28Days |
BUTRANS 15 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover BUTRANS 15 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:4 /28Days |
Butrans 20ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 20ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:4 /28Days |
Butrans 5ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 5ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:4 /28Days |
BUTRANS 7.5 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover BUTRANS 7.5 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | Q:4 /28Days |
BYDUREON 2 MG PEN INJECT ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON 2 MG PEN INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | S Q:4 /28Days |
BYDUREON 2 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON 2 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | S Q:4 /28Days |
BYDUREON BCISE 2 MG AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON BCISE 2 MG AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | S Q:4 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | S Q:2 /30Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | N/A | S Q:1 /30Days |
Bystolic 10mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 10mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Bystolic 2.5mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 2.5mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BYSTOLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BYSTOLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
Bystolic 5mg 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 5mg 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |
BYVALSON 5 MG-80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BYVALSON 5 MG-80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$84.00 | N/A | None |