2020 Medicare Part D Plan Formulary Information |
Essence Rx (HMO-POS) (H5211-002-0)
Benefit Details
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The Essence Rx (HMO-POS) (H5211-002-0) Formulary Drugs Starting with the Letter C in Marathon County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $80.00 Deductible: $330 |
Drugs Starting with Letter C
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
CABERGOLINE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABERGOLINE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:16 /28Days |
CABOMETYX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:30 /30Days |
CABOMETYX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:30 /30Days |
CABOMETYX 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CABOMETYX 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:30 /30Days |
CALCIPOTRIENE 0.005% CREAM (g) [Dovonex] ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE 0.005% CREAM (g) [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:120 /30Days |
CALCIPOTRIENE 0.005% OINTMENT [Dovonex] ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE 0.005% OINTMENT [Dovonex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:120 /30Days |
CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp] ![Compare how all Medicare Part D PDP plans in WI cover CALCIPOTRIENE 0.005% SOLUTION [Dovonex Scalp].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CALCITONIN SALMON NASAL SPRAY 200IU/SPRY ![Compare how all Medicare Part D PDP plans in WI cover CALCITONIN SALMON NASAL SPRAY 200IU/SPRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:4 /28Days |
CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.25 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol] ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 0.5 MCG CAPSULE [Rocaltrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CALCITRIOL 1 MCG/ML SOLUTION ORAL ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 1 MCG/ML SOLUTION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CALCITRIOL 3 MCG/G OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CALCITRIOL 3 MCG/G OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CALCIUM ACETATE 667 MG GELCAPSULE [PhosLo] ![Compare how all Medicare Part D PDP plans in WI cover CALCIUM ACETATE 667 MG GELCAPSULE [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CALCIUM ACETATE 667 MG TABLET [PhosLo] ![Compare how all Medicare Part D PDP plans in WI cover CALCIUM ACETATE 667 MG TABLET [PhosLo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CALQUENCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CALQUENCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:2 /1Days |
CAMILA 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in WI cover CAMILA 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CAMRESE LO TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAMRESE LO TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CANDESARTAN CILEXETIL 16 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 16 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
CANDESARTAN CILEXETIL 32 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 32 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
CANDESARTAN CILEXETIL 4 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 4 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
CANDESARTAN CILEXETIL 8 MG TABLET [Atacand] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN CILEXETIL 8 MG TABLET [Atacand].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CANDESARTAN-HCTZ 16-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN-HCTZ 16-12.5 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
CANDESARTAN-HCTZ 32-12.5 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN-HCTZ 32-12.5 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT] ![Compare how all Medicare Part D PDP plans in WI cover CANDESARTAN-HCTZ 32-25 MG TABLET [Atacand HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:30 /30Days |
CAPLYTA 42 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CAPLYTA 42 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | Q:30 /30Days |
CAPRELSA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:60 /30Days |
CAPRELSA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPRELSA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:30 /30Days |
CAPTOPRIL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CAPTOPRIL 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CAPTOPRIL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CAPTOPRIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAPTOPRIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 25; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 15mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Captopril and Hydrochlorothiazide 50; 25mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARAFATE SUS 1GM/10ML ![Compare how all Medicare Part D PDP plans in WI cover CARAFATE SUS 1GM/10ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARBAGLU 200 MG DISPER TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAGLU 200 MG DISPER TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P |
CARBAMAZEPINE 100 MG TABLET CHEW ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 100 MG TABLET CHEW.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBAMAZEPINE 100 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 100 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBAMAZEPINE 200 MG TABLET [Tegretol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE 200 MG TABLET [Tegretol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 100 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBAMAZEPINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 200 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol] ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE ER 300 MG CAPSULE CPMP 12HR [Carbatrol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBAMAZEPINE XR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBAMAZEPINE XR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBAMAZEPINE XR 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVEDOPA ORALLY DISINTEGRATING TABLETS 10;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVODOPA ODT 25;100MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA AND LEVODOPA ODT 25;250MG;MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVO ER 25-100 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVO ER 50-200 TABLET [SINEMET CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 10-100 TABLET [SINEMET].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 100 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 125 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 150 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 200 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARBIDOPA-LEVODOPA 25-100 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 25-100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARBIDOPA-LEVODOPA 25-250 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 25-250 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA 75 MG-ENTA TABLET [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo] ![Compare how all Medicare Part D PDP plans in WI cover CARBIDOPA-LEVODOPA-ENTACAPONE 50 MG [Stalevo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CARISOPRODOL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARISOPRODOL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CARISOPRODOL 350 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARISOPRODOL 350 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CARTEOLOL HCL 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover CARTEOLOL HCL 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CARTIA XT 120MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 120MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CARTIA XT 180MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 180MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CARTIA XT 240MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 240MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CARTIA XT 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CARTIA XT 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:30 /30Days |
CARVEDILOL 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARVEDILOL 25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARVEDILOL 3.125 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 3.125 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CARVEDILOL 6.25 MG TABLET [Coreg] ![Compare how all Medicare Part D PDP plans in WI cover CARVEDILOL 6.25 MG TABLET [Coreg].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CASPOFUNGIN ACETATE 50 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CASPOFUNGIN ACETATE 50 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | None |
CASPOFUNGIN ACETATE 70 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CASPOFUNGIN ACETATE 70 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | None |
CAYSTON KIT 75 MG/VIAL ![Compare how all Medicare Part D PDP plans in WI cover CAYSTON KIT 75 MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:84 /28Days |
CAZIANT 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in WI cover CAZIANT 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFACLOR 125 MG/5 ML ORAL SUSPENSION [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 125 MG/5 ML ORAL SUSPENSION [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFACLOR 250 MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 250 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFACLOR 250 MG/5 ML ORAL SUSPENSION [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 250 MG/5 ML ORAL SUSPENSION [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFACLOR 375 MG/5 ML ORAL SUSPENSION [Ceclor] ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 375 MG/5 ML ORAL SUSPENSION [Ceclor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFACLOR 500 MG CAPSULES ![Compare how all Medicare Part D PDP plans in WI cover CEFACLOR 500 MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFADROXIL 1 GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 1 GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFADROXIL 250 MG/5 ML ORAL SUSPENSION [Duricef] ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 250 MG/5 ML ORAL SUSPENSION [Duricef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFADROXIL 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFADROXIL 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEFADROXIL 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFAZOLIN 1 GM VIAL 25/Box ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 1 GM VIAL 25/Box.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE ![Compare how all Medicare Part D PDP plans in WI cover Cefazolin 10g/1 10 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 PACKAGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFAZOLIN 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFAZOLIN 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFDINIR 125 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 125 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef] ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 250 MG/5 ML ORAL SUSPENSION [Omnicef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFDINIR 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEFDINIR 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFEPIME HCL 1 GM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME HCL 1 GM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFEPIME HCL 2 GRAM VIAL [Maxipime] ![Compare how all Medicare Part D PDP plans in WI cover CEFEPIME HCL 2 GRAM VIAL [Maxipime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFIXIME 100 MG/5 ML SUSPENSION [Suprax] ![Compare how all Medicare Part D PDP plans in WI cover CEFIXIME 100 MG/5 ML SUSPENSION [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFIXIME 200 MG/5 ML SUSPENSION [Suprax] ![Compare how all Medicare Part D PDP plans in WI cover CEFIXIME 200 MG/5 ML SUSPENSION [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFIXIME 400 MG CAPSULE [Suprax] ![Compare how all Medicare Part D PDP plans in WI cover CEFIXIME 400 MG CAPSULE [Suprax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFOTETAN 1GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in WI cover CEFOTETAN 1GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFOTETAN 2GM VIAL 1EA x 10 ![Compare how all Medicare Part D PDP plans in WI cover CEFOTETAN 2GM VIAL 1EA x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFOXITIN 1 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 1 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFOXITIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFOXITIN 2 GM VIAL [Mefoxin] ![Compare how all Medicare Part D PDP plans in WI cover CEFOXITIN 2 GM VIAL [Mefoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFPODOXIME 100 MG TABLET [Vantin] ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 100 MG TABLET [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin] ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 100 MG/5 ML ORAL SUSPENSION [Vantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPODOXIME 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPODOXIME 50 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEFPODOXIME 50 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPROZIL 125 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 125 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPROZIL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPROZIL 250 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 250 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFPROZIL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFPROZIL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFTAZIDIME 1 GM VIAL [Tazidime] ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME 1 GM VIAL [Tazidime].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME FOR INJECTION 2GM/VIAL 10 X 2 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN ![Compare how all Medicare Part D PDP plans in WI cover CEFTAZIDIME FOR INJECTION 6GM/VIAL 6 X 6 CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTRIAXONE 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTRIAXONE 10 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 10 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTRIAXONE 2 GM VIAL [Rocephin] ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 2 GM VIAL [Rocephin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTRIAXONE 250 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 250 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFTRIAXONE 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover CEFTRIAXONE 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFUROXIME 1.5 GM/VIAL FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 1.5 GM/VIAL FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFUROXIME 750 MG FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME 750 MG FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEFUROXIME AXETIL 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME AXETIL 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CEFUROXIME AXETIL 500 MG TABLET [Ceftin] ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME AXETIL 500 MG TABLET [Ceftin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEFUROXIME SOD 7.5 GM VIAL [Zinacef] ![Compare how all Medicare Part D PDP plans in WI cover CEFUROXIME SOD 7.5 GM VIAL [Zinacef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CELECOXIB 100 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 100 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CELECOXIB 200 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 200 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CELECOXIB 400 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 400 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CELECOXIB 50 MG CAPSULE [Celebrex] ![Compare how all Medicare Part D PDP plans in WI cover CELECOXIB 50 MG CAPSULE [Celebrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CELONTIN 300 MG KAPSEAL ![Compare how all Medicare Part D PDP plans in WI cover CELONTIN 300 MG KAPSEAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CEPHALEXIN 125 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 125 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CEPHALEXIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CEPHALEXIN 250 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 250 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CEPHALEXIN 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CEPHALEXIN 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CETIRIZINE HCL 1 MG/ML SYRUP SOLUTION [Zyrtec Pre-Filled Spoons] ![Compare how all Medicare Part D PDP plans in WI cover CETIRIZINE HCL 1 MG/ML SYRUP SOLUTION [Zyrtec Pre-Filled Spoons].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:300 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CEVIMELINE HCL 30 MG CAPSULE [Evoxac] ![Compare how all Medicare Part D PDP plans in WI cover CEVIMELINE HCL 30 MG CAPSULE [Evoxac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CHANTIX 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
CHANTIX 1 MG CONT MONTH BOX ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 MG CONT MONTH BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
CHANTIX 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
CHANTIX STARTING MONTH BOX ![Compare how all Medicare Part D PDP plans in WI cover CHANTIX STARTING MONTH BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:60 /30Days |
CHLORDIAZEPOXIDE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CHLORDIAZEPOXIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CHLORDIAZEPOXIDE 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CHLORDIAZEPOXIDE 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CHLORHEXIDINE GLUCONATE 0.12% RINSE ![Compare how all Medicare Part D PDP plans in WI cover CHLORHEXIDINE GLUCONATE 0.12% RINSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CHLOROQUINE PH 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PH 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CHLOROQUINE PH 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLOROQUINE PH 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CHLORPROMAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CHLORPROMAZINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CHLORPROMAZINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CHLORPROMAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CHLORPROMAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORPROMAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CHLORTHALIDONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CHLORTHALIDONE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORTHALIDONE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CHLORZOXAZONE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CHLORZOXAZONE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | P |
CHOLESTYRAMINE LIGHT POWDER ![Compare how all Medicare Part D PDP plans in WI cover CHOLESTYRAMINE LIGHT POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CHOLESTYRAMINE PACKET ![Compare how all Medicare Part D PDP plans in WI cover CHOLESTYRAMINE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CICLOPIROX 0.77% CREAM (g) [Loprox] ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% CREAM (g) [Loprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CICLOPIROX 0.77% GEL ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CICLOPIROX 0.77% TOPICAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 0.77% TOPICAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CICLOPIROX 1% SHAMPOO ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 1% SHAMPOO.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CICLOPIROX 8% SOLUTION [Penlac] ![Compare how all Medicare Part D PDP plans in WI cover CICLOPIROX 8% SOLUTION [Penlac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Cilastatin 250 MG / Imipenem 250 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Cilastatin 250 MG / Imipenem 250 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Cilastatin 500 MG / Imipenem 500 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover Cilastatin 500 MG / Imipenem 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CILOSTAZOL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CILOSTAZOL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CILOSTAZOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CILOSTAZOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CILOXAN 0.3% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CILOXAN 0.3% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CIMDUO 300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CIMDUO 300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | Q:30 /30Days |
Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Cimzia 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIMZIA 200 MG/ML SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover CIMZIA 200 MG/ML SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P |
CINACALCET HCL 30 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in WI cover CINACALCET HCL 30 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:120 /30Days |
CINACALCET HCL 60 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in WI cover CINACALCET HCL 60 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:90 /30Days |
CINACALCET HCL 90 MG TABLET [Sensipar] ![Compare how all Medicare Part D PDP plans in WI cover CINACALCET HCL 90 MG TABLET [Sensipar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P Q:120 /30Days |
Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Cinryze 500[iU]/5mL 1 VIAL per CARTON / 5 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | None |
CIPRO HC OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CIPRO HC OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CIPRODEX OTIC SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CIPRODEX OTIC SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN 0.3% EYE DROPS [Ciloxan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CIPROFLOXACIN HCL 100 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 100 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CIPROFLOXACIN HCL 250 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 250 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CIPROFLOXACIN HCL 500 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 500 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CIPROFLOXACIN HCL 750 MG TABLET [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN HCL 750 MG TABLET [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | None |
CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro] ![Compare how all Medicare Part D PDP plans in WI cover CIPROFLOXACIN-D5W 200 MG/100 ML PIGGYBACK [Cipro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CITALOPRAM HBR 10 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 10 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | Q:60 /30Days |
CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa] ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 10 MG/5 ML SOLUTION [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CITALOPRAM HBR 20 MG TABLET [Celexa] ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 20 MG TABLET [Celexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | Q:60 /30Days |
CITALOPRAM HBR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CITALOPRAM HBR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | Q:90 /30Days |
CLARAVIS 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLARAVIS 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Claravis 30mg 3 BLISTER PACK per CARTON / 10 CAPSULE per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLARAVIS 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLARAVIS 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 125 MG/5ML FOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLARITHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 250 MG/5MLFOR ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLARITHROMYCIN 500 MG TABLET [Biaxin] ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN 500 MG TABLET [Biaxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLARITHROMYCIN ER 500 MG TABLET 24H [Biaxin XL] ![Compare how all Medicare Part D PDP plans in WI cover CLARITHROMYCIN ER 500 MG TABLET 24H [Biaxin XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Clemastine fum 2.68 mg tab ![Compare how all Medicare Part D PDP plans in WI cover Clemastine fum 2.68 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin] ![Compare how all Medicare Part D PDP plans in WI cover CLIND PH-BENZOYL PEROX 1.2-5% [Benzaclin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN 150mg/ml vl 25x6ml ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN 150mg/ml vl 25x6ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN 2% VAGINAL CREAM w/APPL [Clindesse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 150 MG CAPSULE [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLINDAMYCIN HCL 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN HCL 75 MG 200 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLINDAMYCIN PEDIATR 75 MG/5 ML SOLN RECON [Cleocin Pediatric] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PEDIATR 75 MG/5 ML SOLN RECON [Cleocin Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN PH 1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PH 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLINDAMYCIN PH 300 MG/2 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PH 300 MG/2 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PH 600 MG/4 ML VIAL [Cleocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN PHOSP 1% LOTION [ClindaMax] ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSP 1% LOTION [ClindaMax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLINDAMYCIN PHOSPHATE 1% FOAM ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE 1% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Clindamycin Phosphate and Benzoyl Peroxide 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin Phosphate and Benzoyl Peroxide 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE GEL 1% 30GRAM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX ![Compare how all Medicare Part D PDP plans in WI cover CLINDAMYCIN PHOSPHATE TOPICAL SOLUTION USP PLEDGETS 1% 60 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Clindamycin-d5w 300 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 300 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Clindamycin-d5w 600 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 600 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clindamycin-d5w 900 mg/50 ml ![Compare how all Medicare Part D PDP plans in WI cover Clindamycin-d5w 900 mg/50 ml.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX 5%-15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX 5%-15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX E 2.75/5 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 2.75/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX E 4.25/5 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 4.25/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX E 4.25%-10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 4.25%-10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX E 5/20 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 5/20 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINIMIX E 5%-15% IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINIMIX E 5%-15% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLINISOL 15% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLINISOL 15% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOBAZAM 10 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in WI cover CLOBAZAM 10 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI] ![Compare how all Medicare Part D PDP plans in WI cover CLOBAZAM 2.5 MG/ML ORAL SUSPENSION [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:480 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOBAZAM 20 MG TABLET [ONFI] ![Compare how all Medicare Part D PDP plans in WI cover CLOBAZAM 20 MG TABLET [ONFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | Q:60 /30Days |
CLOBETASOL 0.05% CREAM (g) [Temovate] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% CREAM (g) [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL 0.05% OINTMENT [Temovate E] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% OINTMENT [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL 0.05% SOLUTION [Temovate] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% SOLUTION [Temovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL 0.05% TOPICAL LOTION [Clobex] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL 0.05% TOPICAL LOTION [Clobex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL EMOLLIENT 0.05% CREAM (g) [Temovate E] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL EMOLLIENT 0.05% CREAM (g) [Temovate E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL EMOLLNT 0.05% FOAM [Olux-E] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL EMOLLNT 0.05% FOAM [Olux-E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL PROP 0.05% FOAM [Olux] ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL PROP 0.05% FOAM [Olux].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL PROP 0.05% SPRAY ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL PROP 0.05% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Clobetasol Propionate 0.5 MG/ML Medicated Shampoo ![Compare how all Medicare Part D PDP plans in WI cover Clobetasol Propionate 0.5 MG/ML Medicated Shampoo.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLOBETASOL PROPIONATE GEL .05% 60 GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOMIPRAMINE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOMIPRAMINE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOMIPRAMINE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CLOMIPRAMINE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.125 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.25 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.5 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 0.5 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 0.5 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 1 MG DIS TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 1 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 1 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 2 MG ODT TABLET RAPDIS [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLONAZEPAM 2 MG TABLET [Klonopin] ![Compare how all Medicare Part D PDP plans in WI cover CLONAZEPAM 2 MG TABLET [Klonopin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.1mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:4 /28Days |
Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.2mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:4 /28Days |
Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH ![Compare how all Medicare Part D PDP plans in WI cover Clonidine 0.3mg/d 4 POUCH per CARTON / 1 PATCH in 1 POUCH / 7 d in 1 PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:4 /28Days |
CLONIDINE HCL 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLONIDINE HCL 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLONIDINE HCL 0.3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL 0.3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLONIDINE HCL ER 0.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLONIDINE HCL ER 0.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:120 /30Days |
CLOPIDOGREL 75 MG TABLET [Plavix] ![Compare how all Medicare Part D PDP plans in WI cover CLOPIDOGREL 75 MG TABLET [Plavix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$4.00 | $12.00 | Q:37 /30Days |
CLORAZEPATE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLORAZEPATE 3.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 3.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLORAZEPATE 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLORAZEPATE 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOTRIMAZOLE 1% CREAM (g) [Mycelex] ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 1% CREAM (g) [Mycelex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOTRIMAZOLE 1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOTRIMAZOLE 10 MG TROCHE ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE 10 MG TROCHE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOTRIMAZOLE-BETAMETHASONE LOT ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE-BETAMETHASONE LOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE 0.64; 10mg/g; mg/g 45 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CLOVIQUE 250 MG CAPSULE [Syprine] ![Compare how all Medicare Part D PDP plans in WI cover CLOVIQUE 250 MG CAPSULE [Syprine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | None |
CLOZAPINE 100 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 100 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLOZAPINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLOZAPINE 25 MG TABLET [Clozaril] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 25 MG TABLET [Clozaril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLOZAPINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 100 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 12.5 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 150 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 200 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo] ![Compare how all Medicare Part D PDP plans in WI cover CLOZAPINE ODT 25 MG TABLET RAPDIS [Fazaclo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
COARTEM 20MG-120MG ![Compare how all Medicare Part D PDP plans in WI cover COARTEM 20MG-120MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:24 /30Days |
CODEINE SULFATE 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CODEINE SULFATE 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CODEINE SULFATE 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CODEINE SULFATE 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CODEINE SULFATE 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CODEINE SULFATE 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
COLCHICINE 0.6 MG CAPSULE [Mitigare] ![Compare how all Medicare Part D PDP plans in WI cover COLCHICINE 0.6 MG CAPSULE [Mitigare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
COLCHICINE 0.6 MG TABLET [Colcrys] ![Compare how all Medicare Part D PDP plans in WI cover COLCHICINE 0.6 MG TABLET [Colcrys].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
COLESEVELAM 625 MG TABLET [WelChol] ![Compare how all Medicare Part D PDP plans in WI cover COLESEVELAM 625 MG TABLET [WelChol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COLESEVELAM HCL 3.75 G PACKET POWDER PACK [WelChol] ![Compare how all Medicare Part D PDP plans in WI cover COLESEVELAM HCL 3.75 G PACKET POWDER PACK [WelChol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
COLESTIPOL HCL GRANULES PACKET [Colestid] ![Compare how all Medicare Part D PDP plans in WI cover COLESTIPOL HCL GRANULES PACKET [Colestid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
COLESTIPOL MICRONIZED 1 GM TABLET [Colestid] ![Compare how all Medicare Part D PDP plans in WI cover COLESTIPOL MICRONIZED 1 GM TABLET [Colestid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
COLISTIMETHATE 150 MG VIAL [Coly-Mycin M] ![Compare how all Medicare Part D PDP plans in WI cover COLISTIMETHATE 150 MG VIAL [Coly-Mycin M].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
COMBIGAN 0.2%-0.5% DROPS ![Compare how all Medicare Part D PDP plans in WI cover COMBIGAN 0.2%-0.5% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
COMBIVENT RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover COMBIVENT RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:4 /20Days |
COMETRIQ 100 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 100 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:56 /28Days |
COMETRIQ 140 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 140 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:112 /28Days |
COMETRIQ 60 MG DAILY-DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover COMETRIQ 60 MG DAILY-DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:84 /28Days |
COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in WI cover COMPLERA 200; 27.5; 300mg/1; mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | Q:30 /30Days |
COMPRO 25MG SUPPOSITORY ![Compare how all Medicare Part D PDP plans in WI cover COMPRO 25MG SUPPOSITORY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CONSTULOSE 10 GM/15 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover CONSTULOSE 10 GM/15 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
COPIKTRA 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover COPIKTRA 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:56 /28Days |
COPIKTRA 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover COPIKTRA 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:56 /28Days |
CORDRAN 4 MCG/SQ CM LARGE MED. TAPE ![Compare how all Medicare Part D PDP plans in WI cover CORDRAN 4 MCG/SQ CM LARGE MED. TAPE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CORLANOR 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CORLANOR 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
CORLANOR 5 MG/5 ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover CORLANOR 5 MG/5 ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:450 /30Days |
CORLANOR 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CORLANOR 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | Q:60 /30Days |
Cortisone 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover Cortisone 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CORTISPORIN CRE 0.5% ![Compare how all Medicare Part D PDP plans in WI cover CORTISPORIN CRE 0.5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CORTISPORIN OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover CORTISPORIN OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
COSENTYX 300 MG DOSE-2 PENS ![Compare how all Medicare Part D PDP plans in WI cover COSENTYX 300 MG DOSE-2 PENS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
COSENTYX 300 MG DOSE-2 SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover COSENTYX 300 MG DOSE-2 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:2 /28Days |
COTELLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover COTELLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
26% | N/A | P Q:90 /30Days |
Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Creon 256.11mg/1 1 BOTTLE per CARTON / 70 CAPSULE, DELAYED RELEASE in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CREON DELAYED RELEASE CAPSULES 12000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 12000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CREON DELAYED RELEASE CAPSULES 24000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 24000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CREON DELAYED RELEASE CAPSULES 6000MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CREON DELAYED RELEASE CAPSULES 6000MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CREON DR 36,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CREON DR 36,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CRIXIVAN 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:360 /30Days |
CRIXIVAN 400mg, 180 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CRIXIVAN 400mg, 180 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:180 /30Days |
CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom] ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN 100 MG/5 ML ORAL CONC [Gastrocrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal] ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN 20 MG/2 ML NEB SOLN AMPUL-NEB [Intal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CROMOLYN SODIUM 4% 40MG 10ML BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CROMOLYN SODIUM 4% 40MG 10ML BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | None |
CYCLAFEM 1-35-28 TABLET [Pirmella] ![Compare how all Medicare Part D PDP plans in WI cover CYCLAFEM 1-35-28 TABLET [Pirmella].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CYCLAFEM 7-7-7-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLAFEM 7-7-7-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |
CYCLOBENZAPRINE 10 MG TABLET [Flexeril] ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE 10 MG TABLET [Flexeril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | P |
CYCLOBENZAPRINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYCLOBENZAPRINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$12.00 | $36.00 | P |
CYCLOPHOSPHAMIDE 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | P |
CYCLOPHOSPHAMIDE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOPHOSPHAMIDE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | P |
CYCLOSET 0.8MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSET 0.8MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | Q:180 /30Days |
CYCLOSPORINE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CYCLOSPORINE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CYCLOSPORINE MODIFIED 100 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 100 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
CYCLOSPORINE MODIFIED 25 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 25 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CYCLOSPORINE MODIFIED 50 MG ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE MODIFIED 50 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover CYCLOSPORINE ORAL SOLUTION 100MG 50ML BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | P |
CYPROHEPTADINE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL ![Compare how all Medicare Part D PDP plans in WI cover CYPROHEPTADINE HYDROCHLORIDE SOLUTION USP SYRUP 2MG 473 ML BOTGL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 |
$47.00 | $141.00 | None |
CYRED 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover CYRED 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$100.00 | $300.00 | None |