2019 Medicare Part D Plan Formulary Information |
ProHealth Senior Preferred Elite (w/Rx) (HMO) (H5262-011-0)
Benefit Details
![Email Prescription and/or Health Benefit details for ProHealth Senior Preferred Elite (w/Rx) (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The ProHealth Senior Preferred Elite (w/Rx) (HMO) (H5262-011-0) Formulary Drugs Starting with the Letter L in Waukesha County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $20.00 Deductible: $250 |
Drugs Starting with Letter L
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
LABETALOL HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LABETALOL HCL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LABETALOL HCL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LABETALOL HCL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LACRISERT 5 MG INS ![Compare how all Medicare Part D PDP plans in WI cover LACRISERT 5 MG INS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LACTULOSE 10 GM/15 ML SOLUTION [Constulose] ![Compare how all Medicare Part D PDP plans in WI cover LACTULOSE 10 GM/15 ML SOLUTION [Constulose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Lamivudine 10 mg/ml oral soln ![Compare how all Medicare Part D PDP plans in WI cover Lamivudine 10 mg/ml oral soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LAMIVUDINE 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LAMIVUDINE 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Lamivudine hbv 100 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Lamivudine hbv 100 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LAMIVUDINE-ZIDOVUDINE TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMIVUDINE-ZIDOVUDINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE 150MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 150MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LAMOTRIGINE 200MG TABLET (60 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 200MG TABLET (60 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 25 MG DISPER TAB CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LAMOTRIGINE 25 MG TABLET [Subvenite] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 25 MG TABLET [Subvenite].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE 5 MG DISPER TABLET CHW DSP [Lamictal CD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LAMOTRIGINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ER 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ER 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ODT 100 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ODT 200 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ODT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ODT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT] ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE ODT 50 MG TABLET RAPDIS [Lamictal ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LAMOTRIGINE TABLET 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LAMOTRIGINE TABLET 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LANOXIN 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
LANOXIN 250 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 250 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
LANOXIN 62.5 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LANOXIN 62.5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
![Compare how all Medicare Part D PDP plans in WI cover LANSOPRAZOLE DR 15 MG CAPSULE DR [Prevacid]
.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid] ![Compare how all Medicare Part D PDP plans in WI cover LANSOPRAZOLE DR 30 MG CAPSULE [Prevacid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
LANTHANUM CARB 1,000 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in WI cover LANTHANUM CARB 1,000 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LANTHANUM CARB 500 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in WI cover LANTHANUM CARB 500 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
LANTHANUM CARB 750 MG TAB CHEW [Fosrenol] ![Compare how all Medicare Part D PDP plans in WI cover LANTHANUM CARB 750 MG TAB CHEW [Fosrenol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
LANTUS 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LANTUS 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LANTUS SOLOSTAR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover LANTUS SOLOSTAR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LARIN 1.5 MG-30 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LARIN 1.5 MG-30 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LARIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LARIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LARIN FE 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LARIN FE 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LARIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LARIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Larissia-28 tablet ![Compare how all Medicare Part D PDP plans in WI cover Larissia-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LATANOPROST 0.005% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover LATANOPROST 0.005% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LATUDA 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LATUDA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:30 /30Days |
LATUDA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:30 /30Days |
LATUDA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:30 /30Days |
LATUDA 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LATUDA 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
LEENA 28 TABLET [Tri-Norinyl] ![Compare how all Medicare Part D PDP plans in WI cover LEENA 28 TABLET [Tri-Norinyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEFLUNOMIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEFLUNOMIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:30 /30Days |
LEFLUNOMIDE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEFLUNOMIDE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LENVIMA 10 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 10 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 12 MG DAILY DOSE Capsule ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 12 MG DAILY DOSE Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 14 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 14 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 18 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 18 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LENVIMA 20 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 20 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 24 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 24 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LENVIMA 8 MG DAILY DOSE ![Compare how all Medicare Part D PDP plans in WI cover LENVIMA 8 MG DAILY DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Lessina 3 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LETROZOLE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LETROZOLE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEUCOVORIN CALCIUM 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Leucovorin Calcium 15mg/1 24 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Leucovorin Calcium 15mg/1 24 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEUCOVORIN CALCIUM 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEUCOVORIN CALCIUM 5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LEUCOVORIN CALCIUM 5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEUKERAN 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEUKERAN 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEUKINE 250 MCG VIAL ![Compare how all Medicare Part D PDP plans in WI cover LEUKINE 250 MCG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LEUPROLIDE 2WK 14 MG/2.8 ML KT ![Compare how all Medicare Part D PDP plans in WI cover LEUPROLIDE 2WK 14 MG/2.8 ML KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric] ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL 0.31 MG/3 ML SOL VIAL-NEB [Xopenex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL 0.63 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEVALBUTEROL 1.25 MG/0.5 ML ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL 1.25 MG/0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex] ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL 1.25 MG/3 ML SOL VIAL-NEB [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEVALBUTEROL TAR HFA 45MCG INH [Xopenex] ![Compare how all Medicare Part D PDP plans in WI cover LEVALBUTEROL TAR HFA 45MCG INH [Xopenex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:30 /30Days |
LEVEMIR 100UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover LEVEMIR 100UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LEVEMIR FLEXTOUCH 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in WI cover LEVEMIR FLEXTOUCH 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LEVETIRACETAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVETIRACETAM 100 MG/ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 100 MG/ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVETIRACETAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVETIRACETAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVETIRACETAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVETIRACETAM ER 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM ER 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:180 /30Days |
LEVETIRACETAM ER 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVETIRACETAM ER 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:120 /30Days |
LEVO-T 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVO-T 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVO-T 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVO-T 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover LEVOBUNOLOL HYDROCHLORIDE OPHTHALMIC SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVOCARNITINE 1 G/10 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover LEVOCARNITINE 1 G/10 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | P |
LEVOCARNITINE 330 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOCARNITINE 330 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | P |
LEVOCETIRIZINE 2.5 MG/5 ML SOL ![Compare how all Medicare Part D PDP plans in WI cover LEVOCETIRIZINE 2.5 MG/5 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:300 /30Days |
LEVOCETIRIZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOCETIRIZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 0.5% EYE DROPS [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 25 MG/ML SOLUTION [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LEVOFLOXACIN 250 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 250 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOFLOXACIN 500 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 500 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 500 MG/20 ML VIAL [Levaquin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover Levofloxacin 5mg/mL 24 POUCH per CARTON / 1 BAG in 1 POUCH / 100 mL in 1 BAG [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVOFLOXACIN 750 MG TABLET [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 750 MG TABLET [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN] ![Compare how all Medicare Part D PDP plans in WI cover LEVOFLOXACIN 750 MG/150 ML-D5W [LEVAQUIN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LEVONEST-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVONEST-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONO-E ESTRAD 0.10-0.02-0.01 ![Compare how all Medicare Part D PDP plans in WI cover LEVONO-E ESTRAD 0.10-0.02-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONOR-ETH ESTRAD 0.09-0.02 MG ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD 0.09-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVONOR-ETH ESTRAD 0.1-0.02 MG ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD 0.1-0.02 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONOR-ETH ESTRAD 0.15-0.03 ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD 0.15-0.03.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Levonor-eth Estrad 0.15-0.03-0.01 ![Compare how all Medicare Part D PDP plans in WI cover Levonor-eth Estrad 0.15-0.03-0.01.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONOR-ETH ESTRAD TRIPHASIC ![Compare how all Medicare Part D PDP plans in WI cover LEVONOR-ETH ESTRAD TRIPHASIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVONORG 0.15MG-EE 20-25-30MCG ![Compare how all Medicare Part D PDP plans in WI cover LEVONORG 0.15MG-EE 20-25-30MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Levora-28 tablet ![Compare how all Medicare Part D PDP plans in WI cover Levora-28 tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOTHYROXINE 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOTHYROXINE 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOTHYROXINE 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LEVOXYL 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LEVOXYL 137 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 137 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 25 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEVOXYL 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LEVOXYL 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LEXETTE 0.05% FOAM ![Compare how all Medicare Part D PDP plans in WI cover LEXETTE 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LEXIVA 50mg/mL 225 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover LEXIVA 50mg/mL 225 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LIDOCAINE 2% VISCOUS SOLN ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE 2% VISCOUS SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LIDOCAINE 5% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE 5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
Lidocaine 5% patch ![Compare how all Medicare Part D PDP plans in WI cover Lidocaine 5% patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:90 /30Days |
LIDOCAINE HCL 2% JELLY 30ML TUBE ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE HCL 2% JELLY 30ML TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LIDOCAINE HCL IV 4% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE HCL IV 4% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LIDOCAINE-PRILOCAINE CREAM ![Compare how all Medicare Part D PDP plans in WI cover LIDOCAINE-PRILOCAINE CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:30 /30Days |
LINDANE SHAMPOO 1MG 2 FLO BOT ![Compare how all Medicare Part D PDP plans in WI cover LINDANE SHAMPOO 1MG 2 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Linezolid 20 MG/ML Oral Suspension [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover Linezolid 20 MG/ML Oral Suspension [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:1800 /30Days |
LINEZOLID 600 MG TABLET [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover LINEZOLID 600 MG TABLET [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | Q:60 /30Days |
LINEZOLID 600 MG/300 ML IV SOL [Zyvox] ![Compare how all Medicare Part D PDP plans in WI cover LINEZOLID 600 MG/300 ML IV SOL [Zyvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
LINZESS 145 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LINZESS 145 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:30 /30Days |
LINZESS 290 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LINZESS 290 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LINZESS 72 MCG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LINZESS 72 MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:30 /30Days |
LIOTHYRONINE SOD 25 MCG TAB ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SOD 25 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LIOTHYRONINE SOD 5 MCG TAB ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SOD 5 MCG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LIOTHYRONINE SOD 50 MCG TABLET [Cytomel] ![Compare how all Medicare Part D PDP plans in WI cover LIOTHYRONINE SOD 50 MCG TABLET [Cytomel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LISINOPRIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL-HCTZ 10-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL-HCTZ 10-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LISINOPRIL-HCTZ 20-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL-HCTZ 20-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LISINOPRIL-HCTZ 20-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LISINOPRIL-HCTZ 20-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LITHIUM CARBONATE 150 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE 150 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LITHIUM CARBONATE 300 MG Capsule [Eskalith] ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE 300 MG Capsule [Eskalith].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Lithium Carbonate 300 mg tab ![Compare how all Medicare Part D PDP plans in WI cover Lithium Carbonate 300 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
Lithium Carbonate 450mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Lithium Carbonate 450mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LITHIUM CARBONATE 600 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE 600 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LITHIUM CARBONATE ER 300 MG TB ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CARBONATE ER 300 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LITHIUM CIT 8MEQ/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover LITHIUM CIT 8MEQ/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOKELMA 10 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover LOKELMA 10 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
LOKELMA 5 GRAM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover LOKELMA 5 GRAM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LONSURF 15 MG-6.14 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LONSURF 15 MG-6.14 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:100 /28Days |
LONSURF 20 MG-8.19 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LONSURF 20 MG-8.19 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:80 /28Days |
LOPERAMIDE HCL 2MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LOPERAMIDE HCL 2MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra] ![Compare how all Medicare Part D PDP plans in WI cover LOPINAVIR-RITONAVIR 80-20MG/ML Solution [Kaletra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LORAZEPAM 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORAZEPAM 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:150 /30Days |
LORAZEPAM 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORAZEPAM 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:150 /30Days |
LORAZEPAM 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORAZEPAM 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:150 /30Days |
LORAZEPAM 2 MG/ML ORAL CONCENT ![Compare how all Medicare Part D PDP plans in WI cover LORAZEPAM 2 MG/ML ORAL CONCENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:150 /30Days |
LORBRENA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORBRENA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LORBRENA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORBRENA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
LORCET HD 10-325 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LORCET HD 10-325 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Lorcet plus 7.5-325 mg tablet ![Compare how all Medicare Part D PDP plans in WI cover Lorcet plus 7.5-325 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | Q:360 /30Days |
LORYNA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in WI cover LORYNA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN POTASSIUM 100 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 100 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN POTASSIUM 25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN POTASSIUM 50 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN POTASSIUM 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN-HCTZ 100-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 100-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN-HCTZ 100-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 100-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOSARTAN-HCTZ 50-12.5 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover LOSARTAN-HCTZ 50-12.5 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOTEMAX 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover LOTEMAX 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LOTEMAX 0.5% OPHTHALMIC GEL ![Compare how all Medicare Part D PDP plans in WI cover LOTEMAX 0.5% OPHTHALMIC GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Lotemax 5mg/g 1 TUBE per CARTON / 3.5 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LOTEMAX SM 0.38% OPHTH GEL DROPS ![Compare how all Medicare Part D PDP plans in WI cover LOTEMAX SM 0.38% OPHTH GEL DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LOTEPREDNOL ETABONATE 0.5% EYE DROPPER [Lotemax] ![Compare how all Medicare Part D PDP plans in WI cover LOTEPREDNOL ETABONATE 0.5% EYE DROPPER [Lotemax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | None |
LOVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOVASTATIN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOW-OGESTREL-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LOW-OGESTREL-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LOXAPINE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LOXAPINE 25MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE 25MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LOXAPINE CAPSULES 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE CAPSULES 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LOXAPINE CAPSULES 5MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover LOXAPINE CAPSULES 5MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$12.00 | $12.00 | None |
LUCEMYRA 0.18 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LUCEMYRA 0.18 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
40% | 40% | P Q:224 /14Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LUMIGAN 0.01% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover LUMIGAN 0.01% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
LUPANETA PACK 11.25-5 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPANETA PACK 11.25-5 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /84Days |
LUPANETA PACK 3.75-5 MG 1MO KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPANETA PACK 3.75-5 MG 1MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
LUPRON DEPOT 11.25 MG 3MO KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 11.25 MG 3MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 22.5 MG 3MO KIT SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /84Days |
LUPRON DEPOT 3.75 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 3.75 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
LUPRON DEPOT 45 MG 6MO KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 45 MG 6MO KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /84Days |
LUPRON DEPOT 7.5 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT 7.5 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
LUPRON DEPOT-4 MONTH KIT ![Compare how all Medicare Part D PDP plans in WI cover LUPRON DEPOT-4 MONTH KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
LUTERA-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover LUTERA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |
LYNPARZA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYNPARZA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYNPARZA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYNPARZA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
LYRICA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYRICA 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYRICA 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:900 /30Days |
LYRICA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYRICA 225MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 225MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days |
LYRICA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYRICA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:60 /30Days |
LYRICA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYRICA 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover LYRICA 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | Q:90 /30Days |
LYSODREN 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYSODREN 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $118.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
LYZA 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover LYZA 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $4.00 | None |