2020 Medicare Part D Plan Formulary Information |
Anthem MediBlue Access (PPO) (H4036-008-0)
Benefit Details
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The Anthem MediBlue Access (PPO) (H4036-008-0) Formulary Drugs Starting with the Letter M in Green County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $27.00 Deductible: $95 |
Drugs Starting with Letter M
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML ![Compare how all Medicare Part D PDP plans in WI cover M-M-R II VACCINE W/DILUENT 1 DOSE/0.5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MAGNESIUM SULFATE 50% VIAL ![Compare how all Medicare Part D PDP plans in WI cover MAGNESIUM SULFATE 50% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MAGNESIUM SULFATE INJECTION 5 GM/10ML ![Compare how all Medicare Part D PDP plans in WI cover MAGNESIUM SULFATE INJECTION 5 GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MALARONE 250-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MALARONE 250-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MALATHION 0.5% LOTION ![Compare how all Medicare Part D PDP plans in WI cover MALATHION 0.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MAPROTILINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:270 /30Days |
MAPROTILINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:135 /30Days |
MAPROTILINE 75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAPROTILINE 75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MARLISSA-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MARLISSA-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MARPLAN 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover MARPLAN 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MATULANE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MATULANE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MATZIM LA 180 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MATZIM LA 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MATZIM LA 240 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MATZIM LA 240 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MATZIM LA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MATZIM LA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MATZIM LA 360 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MATZIM LA 360 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MATZIM LA 420 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MATZIM LA 420 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MAXZIDE 37.5 MG-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MAXZIDE 37.5 MG-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MAXZIDE 50; 75mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover MAXZIDE 50; 75mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MECLIZINE 12.5 MG TABLET [Antivert] ![Compare how all Medicare Part D PDP plans in WI cover MECLIZINE 12.5 MG TABLET [Antivert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MECLIZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MECLIZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MECLOFENAMATE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MECLOFENAMATE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MECLOFENAMATE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MECLOFENAMATE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MEDROXYPROGESTERONE 10 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE 10 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MEDROXYPROGESTERONE 150 MG/ML SYRINGE [Depo-Provera] ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE 150 MG/ML SYRINGE [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera] ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE 150 MG/ML VIAL [Depo-Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MEDROXYPROGESTERONE 2.5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE 2.5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MEDROXYPROGESTERONE 5 MG TABLET [Provera] ![Compare how all Medicare Part D PDP plans in WI cover MEDROXYPROGESTERONE 5 MG TABLET [Provera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MEFLOQUINE HCL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEFLOQUINE HCL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MEGESTROL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEGESTROL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P |
MEGESTROL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEGESTROL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P |
MEGESTROL ACET 40 MG/ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover MEGESTROL ACET 40 MG/ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P |
MEKINIST 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEKINIST 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MEKINIST 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEKINIST 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:30 /30Days |
MEKTOVI 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MEKTOVI 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P Q:180 /30Days |
MELOXICAM 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MELOXICAM 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MELOXICAM 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MELOXICAM 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MEMANTINE HCL 10 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL 10 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P Q:60 /30Days |
MEMANTINE HCL 2 MG/ML SOLUTION [Namenda] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL 2 MG/ML SOLUTION [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:300 /30Days |
MEMANTINE HCL 5 MG TABLET [Namenda] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL 5 MG TABLET [Namenda].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P Q:90 /30Days |
MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL ER 14 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:30 /30Days |
MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL ER 21 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:30 /30Days |
MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL ER 28 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:30 /30Days |
MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda XR] ![Compare how all Medicare Part D PDP plans in WI cover MEMANTINE HCL ER 7 MG CAPSULE SPR 24 [Namenda XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL ![Compare how all Medicare Part D PDP plans in WI cover Menactra 4; 4; 4; 4ug/0.5mL; ug/0.5mL; ug/0.5mL; ug/0.5mL 5 VIAL, SINGLE-DOSE in 1 PACKAGE / 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MENEST 0.3MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 0.3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MENEST 0.625MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 0.625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MENEST 1.25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MENEST 1.25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MENVEO A-C-Y-W-135-DIP VIAL ![Compare how all Medicare Part D PDP plans in WI cover MENVEO A-C-Y-W-135-DIP VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MERCAPTOPURINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MERCAPTOPURINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MEROPENEM IV 1 GM VIAL [Merrem] ![Compare how all Medicare Part D PDP plans in WI cover MEROPENEM IV 1 GM VIAL [Merrem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MEROPENEM IV 500 MG VIAL [Merrem] ![Compare how all Medicare Part D PDP plans in WI cover MEROPENEM IV 500 MG VIAL [Merrem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MESALAMINE 1,000 MG SUPP.RECT [Canasa] ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE 1,000 MG SUPP.RECT [Canasa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MESALAMINE 4 GM/60 ML ENEMA ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE 4 GM/60 ML ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MESALAMINE 800 MG DR TABLET DR [Asacol HD] ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE 800 MG DR TABLET DR [Asacol HD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MESALAMINE DR 1.2 GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE DR 1.2 GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol] ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE DR 400 MG CAPSULE (DRTAB) [Delzicol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MESALAMINE ER 0.375 GRAM CAPSULE 24H [Apriso] ![Compare how all Medicare Part D PDP plans in WI cover MESALAMINE ER 0.375 GRAM CAPSULE 24H [Apriso].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MESNEX 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MESNEX 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MESTINON 180MG TIMESPAN ![Compare how all Medicare Part D PDP plans in WI cover MESTINON 180MG TIMESPAN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MESTINON 60MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover MESTINON 60MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Metaproterenol Sulfate 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METFORMIN ER 1,000 MG GASTR-TB TABERGR24H [Glumetza] ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN ER 1,000 MG GASTR-TB TABERGR24H [Glumetza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:60 /30Days |
METFORMIN ER 500 MG GASTRC-TB TABERGR24H [Glumetza] ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN ER 500 MG GASTRC-TB TABERGR24H [Glumetza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | Q:120 /30Days |
METFORMIN HCL 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days |
METFORMIN HCL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METFORMIN HCL 850 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL 850 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:90 /30Days |
METFORMIN HCL ER 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
METFORMIN HCL ER 500 MG OSM-TABLET ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 500 MG OSM-TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:120 /30Days |
METFORMIN HCL ER 500 MG TABLET ER 24H [Prozac] ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 500 MG TABLET ER 24H [Prozac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:120 /30Days |
METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR] ![Compare how all Medicare Part D PDP plans in WI cover METFORMIN HCL ER 750 MG TABLET ER 24H [Glucophage XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6* |
Tier 6 |
$0.00 | $0.00 | Q:60 /30Days |
METHADONE 10 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover METHADONE 10 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:900 /30Days |
METHADONE 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover METHADONE 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:900 /30Days |
METHADONE HCL 10 MG TABLET [Methadose] ![Compare how all Medicare Part D PDP plans in WI cover METHADONE HCL 10 MG TABLET [Methadose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:180 /30Days |
METHADONE HCL 5 MG TABLET [Methadose] ![Compare how all Medicare Part D PDP plans in WI cover METHADONE HCL 5 MG TABLET [Methadose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:180 /30Days |
METHAZOLAMIDE 25 MG TABLET [Neptazane] ![Compare how all Medicare Part D PDP plans in WI cover METHAZOLAMIDE 25 MG TABLET [Neptazane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METHAZOLAMIDE 50 MG TABLET [Neptazane] ![Compare how all Medicare Part D PDP plans in WI cover METHAZOLAMIDE 50 MG TABLET [Neptazane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHENAMINE HIPP 1 GM TABLET [Urex] ![Compare how all Medicare Part D PDP plans in WI cover METHENAMINE HIPP 1 GM TABLET [Urex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METHIMAZOLE 10 MG TABLET [Tapazole] ![Compare how all Medicare Part D PDP plans in WI cover METHIMAZOLE 10 MG TABLET [Tapazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METHIMAZOLE 5 MG TABLET [Tapazole] ![Compare how all Medicare Part D PDP plans in WI cover METHIMAZOLE 5 MG TABLET [Tapazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METHOCARBAMOL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHOCARBAMOL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
METHOCARBAMOL 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHOCARBAMOL 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
METHOTREXATE 2.5 MG TABLET [Rheumatrex] ![Compare how all Medicare Part D PDP plans in WI cover METHOTREXATE 2.5 MG TABLET [Rheumatrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METHOTREXATE 50 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover METHOTREXATE 50 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METHOTREXATE 50 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover METHOTREXATE 50 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Methoxsalen 10 mg Capsule [8-MOP] ![Compare how all Medicare Part D PDP plans in WI cover Methoxsalen 10 mg Capsule [8-MOP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
METHSCOPOLAMINE BROM 2.5 MG TABLET [Pamine] ![Compare how all Medicare Part D PDP plans in WI cover METHSCOPOLAMINE BROM 2.5 MG TABLET [Pamine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METHSCOPOLAMINE BROM 5 MG TABLET [Pamine Forte] ![Compare how all Medicare Part D PDP plans in WI cover METHSCOPOLAMINE BROM 5 MG TABLET [Pamine Forte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLDOPA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLDOPA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P |
METHYLDOPA 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLDOPA 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P |
METHYLPHENIDATE 10 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 10 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:90 /30Days |
METHYLPHENIDATE 10 MG/5 ML SOLUTION [Methylin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 10 MG/5 ML SOLUTION [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:900 /30Days |
METHYLPHENIDATE 20 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 20 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:90 /30Days |
METHYLPHENIDATE 5 MG TABLET [Ritalin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 5 MG TABLET [Ritalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:90 /30Days |
METHYLPHENIDATE 5 MG/5 ML SOLUTION [Methylin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE 5 MG/5 ML SOLUTION [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:1800 /30Days |
METHYLPHENIDATE ER 10 MG TABLET [Methylin] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE ER 10 MG TABLET [Methylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:90 /30Days |
METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPHENIDATE ER 20 MG TABLET [Ritalin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:90 /30Days |
METHYLPREDNISOLONE 16 MG TABLET [Medrol Dosepak] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 16 MG TABLET [Medrol Dosepak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METHYLPREDNISOLONE 32 MG TABLET [Medrol] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 32 MG TABLET [Medrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METHYLPREDNISOLONE 4 MG DOSEPK ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 4 MG DOSEPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METHYLPREDNISOLONE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METHYLPREDNISOLONE 8 MG TABLET [Medrol] ![Compare how all Medicare Part D PDP plans in WI cover METHYLPREDNISOLONE 8 MG TABLET [Medrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Metoclopramide 10mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Metoclopramide 10mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOCLOPRAMIDE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOCLOPRAMIDE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOCLOPRAMIDE 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover METOCLOPRAMIDE 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOLAZONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METOLAZONE 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOLAZONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOLAZONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METOPROLOL SUCC ER 100 MG TABLET ER 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 100 MG TABLET ER 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOPROLOL SUCC ER 200 MG TABLET 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 200 MG TABLET 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METOPROLOL SUCC ER 25 MG TABLET 24H [Toprol XL] ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 25 MG TABLET 24H [Toprol XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOPROLOL SUCC ER 50 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL SUCC ER 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOPROLOL TARTRATE 100 MG TABLET [Lopressor] ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE 100 MG TABLET [Lopressor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE 37.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE 37.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT) ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL TARTRATE TABLET FILM COATED 50MG (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
METOPROLOL-HCTZ 100-25 MG TABLET [Lopressor HCT] ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HCTZ 100-25 MG TABLET [Lopressor HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HYDROCHLOROTHIAZIDE 100-50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover METOPROLOL-HYDROCHLOROTHIAZIDE 50MG-25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METRONIDAZOLE 0.75% CREAM (g) [Vitazol] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 0.75% CREAM (g) [Vitazol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
METRONIDAZOLE 0.75% LOTION [MetroLotion] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 0.75% LOTION [MetroLotion].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METRONIDAZOLE 250 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 250 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METRONIDAZOLE 375 MG CAPSULE [Flagyl] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 375 MG CAPSULE [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METRONIDAZOLE 500 MG TABLET [Flagyl] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 500 MG TABLET [Flagyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE 500 MG/100 ML PIGGYBACK [Flagyl RTU].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE TOPICAL 0.75% GL Gel [Nydamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
METRONIDAZOLE TOPICAL 1% GEL [MetroGel] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE TOPICAL 1% GEL [MetroGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole] ![Compare how all Medicare Part D PDP plans in WI cover METRONIDAZOLE VAGINAL 0.75% GL GEL W/APPL [Vandazole].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MEXILETINE 150MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 150MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MEXILETINE 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MEXILETINE 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MEXILETINE 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MICAFUNGIN 100 MG VIAL [Mycamine] ![Compare how all Medicare Part D PDP plans in WI cover MICAFUNGIN 100 MG VIAL [Mycamine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MICAFUNGIN 50 MG VIAL [Mycamine] ![Compare how all Medicare Part D PDP plans in WI cover MICAFUNGIN 50 MG VIAL [Mycamine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MICARDIS 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICARDIS 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICARDIS 80MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS 80MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICARDIS HCT 40/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS HCT 40/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICARDIS HCT 80/12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS HCT 80/12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICARDIS HCT 80/25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICARDIS HCT 80/25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MICONAZOLE 3 200MG SUPPOS. ![Compare how all Medicare Part D PDP plans in WI cover MICONAZOLE 3 200MG SUPPOS..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MICROGESTIN 21 1-20 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN 21 1-20 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MICROGESTIN 21 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN 21 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MICROGESTIN FE 1-20 TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN FE 1-20 TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MICROGESTIN FE 1.5-30 TABLET ![Compare how all Medicare Part D PDP plans in WI cover MICROGESTIN FE 1.5-30 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MIDODRINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MIDODRINE HCL 2.5 MG TABLET [ProAmatine] ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 2.5 MG TABLET [ProAmatine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MIDODRINE HCL 5 MG TABLET [ProAmatine] ![Compare how all Medicare Part D PDP plans in WI cover MIDODRINE HCL 5 MG TABLET [ProAmatine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MIGLITOL 100 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in WI cover MIGLITOL 100 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:90 /30Days |
MIGLITOL 25 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in WI cover MIGLITOL 25 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:360 /30Days |
MIGLITOL 50 MG TABLET [Glyset] ![Compare how all Medicare Part D PDP plans in WI cover MIGLITOL 50 MG TABLET [Glyset].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:180 /30Days |
MIGLUSTAT 100 MG CAPSULE [Zavesca] ![Compare how all Medicare Part D PDP plans in WI cover MIGLUSTAT 100 MG CAPSULE [Zavesca].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
MILI 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in WI cover MILI 0.25-0.035 MG TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MIMVEY 1-0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIMVEY 1-0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MINIPRESS 2MG 250 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover MINIPRESS 2MG 250 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MINITRAN 0.1 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINITRAN 0.1 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINITRAN 0.2 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINITRAN 0.2 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINITRAN 0.4 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINITRAN 0.4 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINITRAN 0.6 MG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINITRAN 0.6 MG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINIVELLE 0.025 MG PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINIVELLE 0.025 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:8 /28Days |
MINIVELLE 0.0375 MG PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINIVELLE 0.0375 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:8 /28Days |
MINIVELLE 0.05 MG PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINIVELLE 0.05 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:8 /28Days |
MINIVELLE 0.075 MG PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINIVELLE 0.075 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:8 /28Days |
MINIVELLE 0.1 MG PATCH ![Compare how all Medicare Part D PDP plans in WI cover MINIVELLE 0.1 MG PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:8 /28Days |
MINOCYCLINE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MINOCYCLINE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINOCYCLINE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINOCYCLINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MINOCYCLINE HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MINOCYCLINE HYDROCHLORIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOCYCLINE HYDROCHLORIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MINOXIDIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOXIDIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MINOXIDIL 2.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MINOXIDIL 2.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MIRAPEX 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIRAPEX 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MIRTAZAPINE 15 MG ODT ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 15 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:90 /30Days |
MIRTAZAPINE 15 MG TABLET [Remeron] ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 15 MG TABLET [Remeron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | Q:90 /30Days |
MIRTAZAPINE 30 MG ODT ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 30 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:45 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MIRTAZAPINE 30 MG TABLET [Remeron] ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 30 MG TABLET [Remeron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | Q:45 /30Days |
MIRTAZAPINE 45 MG ODT ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 45 MG ODT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
MIRTAZAPINE 45 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | Q:30 /30Days |
MIRTAZAPINE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MIRTAZAPINE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
MISOPROSTOL 100 MCG TABLET [Cytotec] ![Compare how all Medicare Part D PDP plans in WI cover MISOPROSTOL 100 MCG TABLET [Cytotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MISOPROSTOL 200 MCG TABLET [Cytotec] ![Compare how all Medicare Part D PDP plans in WI cover MISOPROSTOL 200 MCG TABLET [Cytotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MODAFINIL 100 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in WI cover MODAFINIL 100 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MODAFINIL 200 MG TABLET [Provigil] ![Compare how all Medicare Part D PDP plans in WI cover MODAFINIL 200 MG TABLET [Provigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:60 /30Days |
MOEXIPRIL HCL 15 MG TABLET [Univasc] ![Compare how all Medicare Part D PDP plans in WI cover MOEXIPRIL HCL 15 MG TABLET [Univasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MOEXIPRIL HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOEXIPRIL HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$5.00 | $10.00 | None |
MOLINDONE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOLINDONE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOLINDONE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOLINDONE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MOLINDONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOLINDONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MOMETASONE FUROATE 0.1% CREAM (g) [Elocon] ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 0.1% CREAM (g) [Elocon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MOMETASONE FUROATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MOMETASONE FUROATE 0.1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 0.1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MOMETASONE FUROATE 50 MCG SPRAY ![Compare how all Medicare Part D PDP plans in WI cover MOMETASONE FUROATE 50 MCG SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MONDOXYNE NL 100 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in WI cover MONDOXYNE NL 100 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MONTELUKAST SOD 10 MG TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover MONTELUKAST SOD 10 MG TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MONTELUKAST SOD 4 MG CHEWABLE TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover MONTELUKAST SOD 4 MG CHEWABLE TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MONTELUKAST SOD 4 MG GRANULES [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover MONTELUKAST SOD 4 MG GRANULES [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MONTELUKAST SOD 5 MG CHEWABLE TABLET [Singulair] ![Compare how all Medicare Part D PDP plans in WI cover MONTELUKAST SOD 5 MG CHEWABLE TABLET [Singulair].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MORPHINE SULF 10 MG/5 ML Solution [MSIR] ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF 10 MG/5 ML Solution [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:900 /30Days |
MORPHINE SULF 20 MG/5 ML SOLUTION [MSIR] ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF 20 MG/5 ML SOLUTION [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:900 /30Days |
MORPHINE SULF ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:60 /30Days |
MORPHINE SULF ER 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF ER 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | P Q:90 /30Days |
MORPHINE SULF ER 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF ER 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:60 /30Days |
MORPHINE SULF ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:90 /30Days |
MORPHINE SULF ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULF ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P Q:90 /30Days |
MORPHINE SULFATE 100 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE 100 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
MORPHINE SULFATE IR 15 MG TABLET [MSIR] ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE IR 15 MG TABLET [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
MORPHINE SULFATE IR 30 MG TABLET [MSIR] ![Compare how all Medicare Part D PDP plans in WI cover MORPHINE SULFATE IR 30 MG TABLET [MSIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:180 /30Days |
MOVANTIK 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOVANTIK 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MOVANTIK 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MOVANTIK 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | Q:30 /30Days |
MOVIPREP 7.5-2.691G POWDER IN PACKET ![Compare how all Medicare Part D PDP plans in WI cover MOVIPREP 7.5-2.691G POWDER IN PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MOXIFLOXACIN 0.5% EYE DROPS [Vigamox] ![Compare how all Medicare Part D PDP plans in WI cover MOXIFLOXACIN 0.5% EYE DROPS [Vigamox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
MOXIFLOXACIN HCL 400 MG TABLET [Avelox ABC Pack] ![Compare how all Medicare Part D PDP plans in WI cover MOXIFLOXACIN HCL 400 MG TABLET [Avelox ABC Pack].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$42.00 | $84.00 | None |
Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Multaq 400mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:60 /30Days |
MUPIROCIN 2% CREAM (g) [Bactroban] ![Compare how all Medicare Part D PDP plans in WI cover MUPIROCIN 2% CREAM (g) [Bactroban].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MUPIROCIN 2% OINTMENT [Centany AT] ![Compare how all Medicare Part D PDP plans in WI cover MUPIROCIN 2% OINTMENT [Centany AT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | None |
MYCAMINE 100MG/VIAL FOR INJECTION SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover MYCAMINE 100MG/VIAL FOR INJECTION SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MYCAMINE 50MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover MYCAMINE 50MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | None |
MYCOPHENOLATE 200 MG/ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLATE 200 MG/ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
31% | N/A | P |
MYCOPHENOLATE 250 MG CAPSULE [CellCept] ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLATE 250 MG CAPSULE [CellCept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
MYCOPHENOLATE 500 MG TABLET [CellCept] ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLATE 500 MG TABLET [CellCept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$15.00 | $30.00 | P |
MYCOPHENOLIC ACID DR 180 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLIC ACID DR 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MYCOPHENOLIC ACID DR 360 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYCOPHENOLIC ACID DR 360 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | P |
MYORISAN 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MYORISAN 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
Myorisan 30 mg capsule ![Compare how all Medicare Part D PDP plans in WI cover Myorisan 30 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MYORISAN 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover MYORISAN 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | None |
MYRBETRIQ ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYRBETRIQ ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:30 /30Days |
MYRBETRIQ ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover MYRBETRIQ ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$95.00 | $190.00 | Q:30 /30Days |