2020 Medicare Part D Plan Formulary Information |
iCare Medicare Plan (HMO D-SNP) (H2237-001-0)
Benefit Details
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The iCare Medicare Plan (HMO D-SNP) (H2237-001-0) Formulary Drugs Starting with the Letter F in Sauk County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $39.90 Deductible: $435 |
Drugs Starting with Letter F
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
FALMINA-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover FALMINA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FAMCICLOVIR 125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FAMCICLOVIR 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FAMCICLOVIR 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMCICLOVIR 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FAMOTIDINE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FAMOTIDINE 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FAMOTIDINE 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FANAPT 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:60 /30Days |
FANAPT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FANAPT 12 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FANAPT 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FANAPT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:60 /30Days |
FANAPT 6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FANAPT 8 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FANAPT 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FANAPT TITR TABLETS ![Compare how all Medicare Part D PDP plans in WI cover FANAPT TITR TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S |
FARYDAK 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FARYDAK 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FARYDAK 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FARYDAK 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FASENRA 30 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover FASENRA 30 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:1 /28Days |
FASENRA PEN 30 MG/ML AUTO INJCT ![Compare how all Medicare Part D PDP plans in WI cover FASENRA PEN 30 MG/ML AUTO INJCT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:1 /28Days |
FEBUXOSTAT 40 MG TABLET [Uloric] ![Compare how all Medicare Part D PDP plans in WI cover FEBUXOSTAT 40 MG TABLET [Uloric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:30 /30Days |
FEBUXOSTAT 80 MG TABLET [Uloric] ![Compare how all Medicare Part D PDP plans in WI cover FEBUXOSTAT 80 MG TABLET [Uloric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:30 /30Days |
FELBAMATE 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FELBAMATE 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FELBAMATE 600 MG TABLET [Felbatol] ![Compare how all Medicare Part D PDP plans in WI cover FELBAMATE 600 MG TABLET [Felbatol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FELBAMATE 600 MG/5 ML ORAL SUSPENSION [Felbatol] ![Compare how all Medicare Part D PDP plans in WI cover FELBAMATE 600 MG/5 ML ORAL SUSPENSION [Felbatol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FEMRING 0.05 MG/DAY VAGINAL RING ![Compare how all Medicare Part D PDP plans in WI cover FEMRING 0.05 MG/DAY VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:1 /84Days |
FEMRING 0.10 MG/DAY VAGINAL RING ![Compare how all Medicare Part D PDP plans in WI cover FEMRING 0.10 MG/DAY VAGINAL RING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:1 /84Days |
FEMYNOR 28 TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in WI cover FEMYNOR 28 TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 134MG CAPSULE [LIPOFEN] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 134MG CAPSULE [LIPOFEN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 145 MG TABLET [Tricor] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 145 MG TABLET [Tricor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 160 MG TABLET [LIPOFEN] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 160 MG TABLET [LIPOFEN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 200 MG CAPSULE [LIPOFEN] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 200 MG CAPSULE [LIPOFEN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 48 MG TABLET [Tricor] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 48 MG TABLET [Tricor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENOFIBRATE 54 MG 90 TABLET BOTTLE [LIPOFEN] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 54 MG 90 TABLET BOTTLE [LIPOFEN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENOFIBRATE 67MG CAPSULE [LIPOFEN] ![Compare how all Medicare Part D PDP plans in WI cover FENOFIBRATE 67MG CAPSULE [LIPOFEN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FENTANYL 100 MCG/HR PATCH TD72 [Duragesic] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 100 MCG/HR PATCH TD72 [Duragesic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:10 /30Days |
FENTANYL 12 MCG/HR PATCH TD72 [Duragesic] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 12 MCG/HR PATCH TD72 [Duragesic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:10 /30Days |
FENTANYL 25 MCG/HR PATCH TD72 [Duragesic] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 25 MCG/HR PATCH TD72 [Duragesic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:10 /30Days |
FENTANYL 50 MCG/HR PATCH TD72 [Duragesic] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 50 MCG/HR PATCH TD72 [Duragesic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:10 /30Days |
FENTANYL 75 MCG/HR PATCH TD72 [Duragesic] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL 75 MCG/HR PATCH TD72 [Duragesic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:10 /30Days |
FENTANYL CIT OTFC 1,200 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CIT OTFC 1,200 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
FENTANYL CIT OTFC 1,600 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CIT OTFC 1,600 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
FENTANYL CITRATE OTFC 200 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE OTFC 200 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
FENTANYL CITRATE OTFC 400 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE OTFC 400 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
FENTANYL CITRATE OTFC 600 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE OTFC 600 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FENTANYL CITRATE OTFC 800 MCG LOZENGE HD [Actiq] ![Compare how all Medicare Part D PDP plans in WI cover FENTANYL CITRATE OTFC 800 MCG LOZENGE HD [Actiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P Q:120 /30Days |
FERRIPROX 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FERRIPROX 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FERRIPROX 100 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FERRIPROX 100 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FERRIPROX 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FERRIPROX 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FETZIMA 20-40 MG TITRATION PAK ![Compare how all Medicare Part D PDP plans in WI cover FETZIMA 20-40 MG TITRATION PAK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S |
FETZIMA ER 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FETZIMA ER 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:30 /30Days |
FETZIMA ER 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FETZIMA ER 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:30 /30Days |
FETZIMA ER 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FETZIMA ER 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:30 /30Days |
FETZIMA ER 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FETZIMA ER 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:30 /30Days |
FIASP 100 UNIT/ML FLEXTOUCH INSULIN PEN ![Compare how all Medicare Part D PDP plans in WI cover FIASP 100 UNIT/ML FLEXTOUCH INSULIN PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:30 /28Days |
FIASP 100 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover FIASP 100 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:40 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FIASP PENFILL 100 UNIT/ML CART CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover FIASP PENFILL 100 UNIT/ML CART CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:30 /28Days |
FINASTERIDE 5 MG TABLET [Proscar] ![Compare how all Medicare Part D PDP plans in WI cover FINASTERIDE 5 MG TABLET [Proscar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FIRVANQ 25 MG/ML SOLUTION SOLN RECON ![Compare how all Medicare Part D PDP plans in WI cover FIRVANQ 25 MG/ML SOLUTION SOLN RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | None |
FIRVANQ 50 MG/ML SOLUTION RECON ![Compare how all Medicare Part D PDP plans in WI cover FIRVANQ 50 MG/ML SOLUTION RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | None |
FLEBOGAMMA DIF INJECTION ![Compare how all Medicare Part D PDP plans in WI cover FLEBOGAMMA DIF INJECTION .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FLECAINIDE ACETATE 100 MG TABLET [Tambocor] ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 100 MG TABLET [Tambocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLECAINIDE ACETATE 150 MG TABLET [Tambocor] ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 150 MG TABLET [Tambocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLECAINIDE ACETATE 50 MG TABLET [Tambocor] ![Compare how all Medicare Part D PDP plans in WI cover FLECAINIDE ACETATE 50 MG TABLET [Tambocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS 100ug/1 60 POWDER, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:60 /30Days |
FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS 250ug/1 60 POWDER, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:120 /30Days |
FLOVENT DISKUS POWDER 50MCG 60 CTR ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT DISKUS POWDER 50MCG 60 CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 110ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:12 /28Days |
FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 220ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:24 /28Days |
FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER ![Compare how all Medicare Part D PDP plans in WI cover FLOVENT HFA 44ug/1 120 AEROSOL, METERED in 1 INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | Q:21 /28Days |
FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 10 MG/ML ORAL SUSPENSION [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE 100 MG TABLET [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 100 MG TABLET [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE 150 MG TABLET [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 150 MG TABLET [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE 200 MG TABLET [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 200 MG TABLET [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 40 MG/ML ORAL SUSPENSION [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE 50 MG TABLET [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE 50 MG TABLET [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUCONAZOLE-NACL 200 MG/100 ML PIGGYBACK [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE-NACL 200 MG/100 ML PIGGYBACK [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | P |
FLUCONAZOLE-NACL 400 MG/200 ML PIGGYBACK [Diflucan] ![Compare how all Medicare Part D PDP plans in WI cover FLUCONAZOLE-NACL 400 MG/200 ML PIGGYBACK [Diflucan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUCYTOSINE 250 MG CAPSULE [Ancobon] ![Compare how all Medicare Part D PDP plans in WI cover FLUCYTOSINE 250 MG CAPSULE [Ancobon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FLUCYTOSINE 500 MG CAPSULE [Ancobon] ![Compare how all Medicare Part D PDP plans in WI cover FLUCYTOSINE 500 MG CAPSULE [Ancobon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FLUDROCORTISONE 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUDROCORTISONE 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL ![Compare how all Medicare Part D PDP plans in WI cover FLUNISOLIDE NASAL SOLUTION 0.025% 25ML INHL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:50 /25Days |
FLUOCINOLONE 0.01% CREAM (g) ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.01% CREAM (g).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOCINOLONE 0.025% CREAM (g) [Synalar] ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.025% CREAM (g) [Synalar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOCINOLONE 0.025% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINOLONE 0.025% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOCINONIDE 0.05% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE 0.05% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOCINONIDE-E 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOCINONIDE-E 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Fluorometholone 0.1% drops ![Compare how all Medicare Part D PDP plans in WI cover Fluorometholone 0.1% drops.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | None |
FLUOROURACIL 0.5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 0.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUOROURACIL 2% TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 2% TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOROURACIL 5% CREAM (g) [Efudex] ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 5% CREAM (g) [Efudex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOROURACIL 5% TOPICAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FLUOROURACIL 5% TOPICAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Fluoxetine 20mg/5mL 120 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOXETINE HCL 10 MG CAPSULE [Selfemra] ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE HCL 10 MG CAPSULE [Selfemra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOXETINE HCL 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE HCL 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUOXETINE HCL 40 MG CAPSULE [Prozac] ![Compare how all Medicare Part D PDP plans in WI cover FLUOXETINE HCL 40 MG CAPSULE [Prozac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 10 MG TABLET [Prolixin] ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 10 MG TABLET [Prolixin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 2.5 MG/5 ML ELIX ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 2.5 MG/5 ML ELIX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUPHENAZINE 2.5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 2.5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE 5MG/ML CONC ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE 5MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUPHENAZINE DEC 125 MG/5 ML VIAL [Prolixin Decanoate] ![Compare how all Medicare Part D PDP plans in WI cover FLUPHENAZINE DEC 125 MG/5 ML VIAL [Prolixin Decanoate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLURBIPROFEN 0.03% EYE DROPS [Ocufen] ![Compare how all Medicare Part D PDP plans in WI cover FLURBIPROFEN 0.03% EYE DROPS [Ocufen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Flurbiprofen 100mg/1 100 BOTTLE in 1 BOTTLE / 100 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Flurbiprofen 100mg/1 100 BOTTLE in 1 BOTTLE / 100 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUTAMIDE 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover FLUTAMIDE 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUTICASONE PROP 0.005% OINTMENT [Cutivate] ![Compare how all Medicare Part D PDP plans in WI cover FLUTICASONE PROP 0.005% OINTMENT [Cutivate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Fluticasone Propionate 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Fluticasone Propionate 0.5mg/g 1 TUBE per CARTON / 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUTICASONE PROPIONATE 50 MCG SPRAY SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover FLUTICASONE PROPIONATE 50 MCG SPRAY SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | Q:16 /30Days |
FLUVOXAMINE MALEATE 100 MG TABLET [Luvox] ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 100 MG TABLET [Luvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FLUVOXAMINE MALEATE 25 MG TABLET [Luvox] ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 25 MG TABLET [Luvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FLUVOXAMINE MALEATE 50 MG TABLET [Luvox] ![Compare how all Medicare Part D PDP plans in WI cover FLUVOXAMINE MALEATE 50 MG TABLET [Luvox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FONDAPARINUX 10 MG/0.8 ML SYRINGE [Arixtra] ![Compare how all Medicare Part D PDP plans in WI cover FONDAPARINUX 10 MG/0.8 ML SYRINGE [Arixtra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FONDAPARINUX 2.5 MG/0.5 ML SYRINGE [Arixtra] ![Compare how all Medicare Part D PDP plans in WI cover FONDAPARINUX 2.5 MG/0.5 ML SYRINGE [Arixtra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FONDAPARINUX 5 MG/0.4 ML SYRINGE [Arixtra] ![Compare how all Medicare Part D PDP plans in WI cover FONDAPARINUX 5 MG/0.4 ML SYRINGE [Arixtra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FONDAPARINUX 7.5 MG/0.6 ML SYRINGE [Arixtra] ![Compare how all Medicare Part D PDP plans in WI cover FONDAPARINUX 7.5 MG/0.6 ML SYRINGE [Arixtra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
Forteo 250ug/mL 1 SYRINGE per CARTON / 2.4 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover Forteo 250ug/mL 1 SYRINGE per CARTON / 2.4 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | P Q:2 /28Days |
FOSAMPRENAVIR 700 MG TABLET [Lexiva] ![Compare how all Medicare Part D PDP plans in WI cover FOSAMPRENAVIR 700 MG TABLET [Lexiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FOSINOPRIL SODIUM 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FOSINOPRIL SODIUM 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FOSINOPRIL SODIUM 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FOSINOPRIL SODIUM 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FREAMINE HBC INJECTION ![Compare how all Medicare Part D PDP plans in WI cover FREAMINE HBC INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | P |
FULPHILA 6 MG/0.6 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover FULPHILA 6 MG/0.6 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | P |
FUROSEMIDE 10 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 10 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUROSEMIDE 100 MG/10 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 100 MG/10 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
Furosemide 10mg/mL 10 CARTON in 1 CONTAINER / 1 SYRINGE, PLASTIC in 1 CARTON / 4 mL in 1 SYRINGE, P ![Compare how all Medicare Part D PDP plans in WI cover Furosemide 10mg/mL 10 CARTON in 1 CONTAINER / 1 SYRINGE, PLASTIC in 1 CARTON / 4 mL in 1 SYRINGE, P.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUROSEMIDE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUROSEMIDE 40 MG TABLET [Lasix] ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 40 MG TABLET [Lasix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUROSEMIDE 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUROSEMIDE 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FUROSEMIDE 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | None |
FUZEON 90 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover FUZEON 90 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | None |
FYAVOLV 1 MG-5 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYAVOLV 1 MG-5 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$15.00 | $45.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
FYCOMPA 0.5 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 0.5 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:720 /30Days |
FYCOMPA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:30 /30Days |
FYCOMPA 12 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 12 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:30 /30Days |
FYCOMPA 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 |
$45.00 | $135.00 | S Q:30 /30Days |
FYCOMPA 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FYCOMPA 6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:60 /30Days |
FYCOMPA 8 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover FYCOMPA 8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
25% | N/A | S Q:30 /30Days |