2019 Medicare Part D Plan Formulary Information |
Dean Advantage Assurance (HMO) (H9096-001-0)
Benefit Details
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The Dean Advantage Assurance (HMO) (H9096-001-0) Formulary Drugs Starting with the Letter I in Jefferson County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $40.00 Deductible: $350 |
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE SODIUM 150 MG TABLET [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IBRANCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:21 /28Days |
IBRANCE 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:21 /28Days |
IBRANCE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:21 /28Days |
Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Ibuprofen 100mg/5mL 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
IBUPROFEN 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IBUPROFEN 600 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 600 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IBUPROFEN 600mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 600mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IBUPROFEN 800 MG ORAL TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 800 MG ORAL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IBUPROFEN 800 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ICLUSIG 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
ICLUSIG 45 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
IDHIFA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IDHIFA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
IDHIFA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IDHIFA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
ILEVRO 0.3% OPHTH DROPS ![Compare how all Medicare Part D PDP plans in WI cover ILEVRO 0.3% OPHTH DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
IMATINIB MESYLATE 100 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in WI cover IMATINIB MESYLATE 100 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
IMATINIB MESYLATE 400 MG TAB [Gleevec] ![Compare how all Medicare Part D PDP plans in WI cover IMATINIB MESYLATE 400 MG TAB [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
IMBRUVICA 140 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 140 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:90 /30Days |
IMBRUVICA 140 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 140 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:30 /30Days |
IMBRUVICA 280 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 280 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:30 /30Days |
IMBRUVICA 420 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 420 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMBRUVICA 560 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 560 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:30 /30Days |
IMBRUVICA 70 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 70 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P Q:30 /30Days |
IMIPRAMINE HCL 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIPRAMINE HCL 25MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 25MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIPRAMINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | P |
IMIPRAMINE PAMOATE 100MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 100MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIPRAMINE PAMOATE 125MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 125MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIPRAMINE PAMOATE 150MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 150MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIPRAMINE PAMOATE 75MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 75MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IMIQUIMOD 3.75% CREAM PUMP CRM MD PMP [Zyclara] ![Compare how all Medicare Part D PDP plans in WI cover IMIQUIMOD 3.75% CREAM PUMP CRM MD PMP [Zyclara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
IMIQUIMOD 5% CREAM PACKET ![Compare how all Medicare Part D PDP plans in WI cover IMIQUIMOD 5% CREAM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IMOVAX RABIES VACCINE ![Compare how all Medicare Part D PDP plans in WI cover IMOVAX RABIES VACCINE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | P |
INCASSIA 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in WI cover INCASSIA 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
INCRUSE ELLIPTA 62.5 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover INCRUSE ELLIPTA 62.5 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Indapamide 1.25mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
INDAPAMIDE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INDAPAMIDE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
INDOMETHACIN 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
INDOMETHACIN 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
INFANRIX DTAP VIAL ![Compare how all Medicare Part D PDP plans in WI cover INFANRIX DTAP VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
INGREZZA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
INGREZZA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INLYTA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
INLYTA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
INNOPRAN XL 120 MG CAPSULE Capsule ER 24H ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN XL 120 MG CAPSULE Capsule ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INNOPRAN XL 80 MG CAPSULE Capsule ER 24H ![Compare how all Medicare Part D PDP plans in WI cover INNOPRAN XL 80 MG CAPSULE Capsule ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INTELENCE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Intelence 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Intelence 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
INTELENCE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INTRALIPID 20% IV FAT EMUL EMULSION ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 20% IV FAT EMUL EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
INTRALIPID 30% IV FAT EMUL ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 30% IV FAT EMUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | P |
INTRON A 10 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 10 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INTRON A 18 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 18 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INTRON A 25 MILLION UNIT/2.5ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 25 MILLION UNIT/2.5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
INTRON A 50 MILLION UNITS VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 50 MILLION UNITS VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
INTRON A 6MMU/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover INTRON A 6MMU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin] ![Compare how all Medicare Part D PDP plans in WI cover INTROVALE 0.15-0.03 MG TABLET TBDSPK 3MO [Setlakin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
INVANZ 1GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover INVANZ 1GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 117 mg/0.75mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Invega Sustenna 156 mg/mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 156 mg/mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 234 mg/1.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 39 mg/0.25mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 78 mg/0.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
INVEGA TRINZA 273 MG/0.875 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 273 MG/0.875 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVEGA TRINZA 410 MG/1.315 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 410 MG/1.315 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INVEGA TRINZA 546 MG/1.75 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 546 MG/1.75 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INVEGA TRINZA 819 MG/2.625 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 819 MG/2.625 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
INVIRASE 500MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVIRASE 500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
IONOSOL MB-D5W IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover IONOSOL MB-D5W IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in WI cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML ![Compare how all Medicare Part D PDP plans in WI cover IPRAT-ALBUT 0.5-3(2.5) MG/3 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IPRATROPIUM 0.06% SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM 0.06% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
IPRATROPIUM BR 0.02% SOLN ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BR 0.02% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IPRATROPIUM BROMIDE NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BROMIDE NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IRBESARTAN 150 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 150 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IRBESARTAN 300 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 300 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IRBESARTAN 75 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 75 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
IRESSA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IRESSA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | P |
ISENTRESS 100 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ISENTRESS 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
ISENTRESS 25 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 25 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
ISENTRESS HD 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS HD 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
26% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISIBLOOM 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover ISIBLOOM 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ISOLYTE S IV SOLUTION-EXCEL ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE S IV SOLUTION-EXCEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ISONIAZID 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISONIAZID 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
ISORDIL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISORDIL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
ISOSORBIDE DINITRATE 40MG TABLETS ER ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE 40MG TABLETS ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |
ISOSORBIDE DN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOSORBIDE DN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOSORBIDE DN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE DN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOSORBIDE MN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISOSORBIDE MN ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISOSORBIDE MN ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISOSORBIDE MONONITRATE 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONITRATE ER TABLET 120MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $12.00 | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOTONIC GENTAMICIN 100 MG/100 ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTONIC GENTAMICIN 100 MG/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOTONIC GENTAMICIN 80 MG/50 ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTONIC GENTAMICIN 80 MG/50 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOTRETINOIN 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ISOTRETINOIN 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOTRETINOIN 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ISOTRETINOIN 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOTRETINOIN 30 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ISOTRETINOIN 30 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISOTRETINOIN 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ISOTRETINOIN 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISRADIPINE CAPSULES 2.5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 2.5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISRADIPINE CAPSULES 5MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE CAPSULES 5MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
ISTALOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover ISTALOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | $300.00 | None |
ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox] ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
ITRACONAZOLE 100 MG CAPSULE [Sporanox] ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 100 MG CAPSULE [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | P |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] ![Compare how all Medicare Part D PDP plans in WI cover IVERMECTIN 3 MG TABLET [Stromectol, Sklice].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$14.00 | $28.00 | None |
IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML ![Compare how all Medicare Part D PDP plans in WI cover IXIARO JAPANESE ENCEPHALITIS VACCINE 6MCG/.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $117.50 | None |