2020 Medicare Part D Plan Formulary Information |
Network PlatinumSelect (PPO) (H5215-008-0)
Benefit Details
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The Network PlatinumSelect (PPO) (H5215-008-0) Formulary Drugs Starting with the Letter P in Portage County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $0.00 Deductible: $395 |
Drugs Starting with Letter P
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
PACERONE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PACERONE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PACERONE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PACERONE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PACERONE 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PACERONE 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PALIPERIDONE ER 1.5 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in WI cover PALIPERIDONE ER 1.5 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S |
PALIPERIDONE ER 3 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in WI cover PALIPERIDONE ER 3 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S Q:30 /30Days |
PALIPERIDONE ER 6 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in WI cover PALIPERIDONE ER 6 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S Q:60 /30Days |
PALIPERIDONE ER 9 MG TABLET [INVEGA] ![Compare how all Medicare Part D PDP plans in WI cover PALIPERIDONE ER 9 MG TABLET [INVEGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S Q:30 /30Days |
PALYNZIQ 10 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover PALYNZIQ 10 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PALYNZIQ 2.5 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover PALYNZIQ 2.5 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PALYNZIQ 20 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover PALYNZIQ 20 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAMELOR 10mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PAMELOR 10mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAMELOR 25mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PAMELOR 25mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAMELOR 50mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PAMELOR 50mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAMELOR 75mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PAMELOR 75mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANCREAZE DR 10,500 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PANCREAZE DR 10,500 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANCREAZE DR 16,800 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PANCREAZE DR 16,800 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANCREAZE DR 2,600 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PANCREAZE DR 2,600 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANCREAZE DR 21,000 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PANCREAZE DR 21,000 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PANCREAZE DR 4,200 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PANCREAZE DR 4,200 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANDEL 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover PANDEL 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PANRETIN 0.1% GEL 60GM TUBE ![Compare how all Medicare Part D PDP plans in WI cover PANRETIN 0.1% GEL 60GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PANTOPRAZOLE SOD DR 20 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PANTOPRAZOLE SOD DR 20 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PANTOPRAZOLE SOD DR 40 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PANTOPRAZOLE SOD DR 40 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PANZYGA 10% (1 G/10 ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (1 G/10 ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PANZYGA 10% (10 G/100 ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (10 G/100 ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PANZYGA 10% (2.5 G/25 ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (2.5 G/25 ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PANZYGA 10% (20G/200ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (20G/200ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PANZYGA 10% (30 G/300 ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (30 G/300 ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PANZYGA 10% (5 G/50 ML) VIAL ![Compare how all Medicare Part D PDP plans in WI cover PANZYGA 10% (5 G/50 ML) VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PARICALCITOL 1 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in WI cover PARICALCITOL 1 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PARICALCITOL 2 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in WI cover PARICALCITOL 2 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PARICALCITOL 4 MCG CAPSULE [Zemplar] ![Compare how all Medicare Part D PDP plans in WI cover PARICALCITOL 4 MCG CAPSULE [Zemplar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PARLODEL 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PARLODEL 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PARLODEL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PARLODEL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PARNATE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PARNATE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAROMOMYCIN 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PAROMOMYCIN 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAROXETINE ER 12.5 MG TABLET 24H [Paxil CR] ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE ER 12.5 MG TABLET 24H [Paxil CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PAROXETINE ER 25 MG TABLET 24H [Paxil CR] ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE ER 25 MG TABLET 24H [Paxil CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PAROXETINE ER 37.5 MG TABLET ER 24H [Paxil CR] ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE ER 37.5 MG TABLET ER 24H [Paxil CR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PAROXETINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PAROXETINE HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PAROXETINE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PAROXETINE HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAROXETINE MESYLATE 7.5 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover PAROXETINE MESYLATE 7.5 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PASER GRANULES 4GM PACKET ![Compare how all Medicare Part D PDP plans in WI cover PASER GRANULES 4GM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PATANASE 665ug/1 240 SPRAY, METERED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PATANASE 665ug/1 240 SPRAY, METERED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:31 /30Days |
PAXIL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAXIL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAXIL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL 25mg/1 ![Compare how all Medicare Part D PDP plans in WI cover PAXIL 25mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PAXIL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL CR TABLETS CONTROLLED RELEASE 12.5 MG ![Compare how all Medicare Part D PDP plans in WI cover PAXIL CR TABLETS CONTROLLED RELEASE 12.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL CR TABLETS EXTENDED RELEASE 37.5 MG ![Compare how all Medicare Part D PDP plans in WI cover PAXIL CR TABLETS EXTENDED RELEASE 37.5 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL ORAL SUSPENSION 10 MG/5ML ![Compare how all Medicare Part D PDP plans in WI cover PAXIL ORAL SUSPENSION 10 MG/5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PAXIL TABLETS 40 MG ![Compare how all Medicare Part D PDP plans in WI cover PAXIL TABLETS 40 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PAZEO 0.7% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover PAZEO 0.7% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PEDVAXHIB VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover PEDVAXHIB VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte] ![Compare how all Medicare Part D PDP plans in WI cover PEG 3350-ELECTROLYTE SOLUTION RECON [TriLyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PEG-3350 AND ELECTROLYTES SOLN SOLN RECON ![Compare how all Medicare Part D PDP plans in WI cover PEG-3350 AND ELECTROLYTES SOLN SOLN RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PEGANONE 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEGANONE 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in WI cover Pegasys 180ug/0.5mL 1 PACKET in 1 BOX / 4 SYRINGE, GLASS in 1 PACKET / 0.5 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PEGASYS INJECTION ![Compare how all Medicare Part D PDP plans in WI cover PEGASYS INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PEGASYS PROCLICK 180 MCG/0.5 ![Compare how all Medicare Part D PDP plans in WI cover PEGASYS PROCLICK 180 MCG/0.5.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PEMAZYRE 13.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEMAZYRE 13.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:21 /28Days |
PEMAZYRE 4.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEMAZYRE 4.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:21 /28Days |
PEMAZYRE 9 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEMAZYRE 9 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:21 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENICILLAMINE 250 MG CAPSULE [Cuprimine] ![Compare how all Medicare Part D PDP plans in WI cover PENICILLAMINE 250 MG CAPSULE [Cuprimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PENICILLAMINE 250 MG TABLET [Depen] ![Compare how all Medicare Part D PDP plans in WI cover PENICILLAMINE 250 MG TABLET [Depen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN G POTASSIUM 2MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN G POTASSIUM 3MMUNITS/50ML ISO-OSM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENICILLIN G PROCAINE 1200000UNT 2ML CTG ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN G PROCAINE 1200000UNT 2ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover Penicillin G Sodium 5000000[iU]/1 10 VIAL per CARTON / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENICILLIN GK 20 MILLION UNIT ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN GK 20 MILLION UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENICILLIN V POTASSIUM 250MG/5ML LIQUID ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN V POTASSIUM 250MG/5ML LIQUID.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PENICILLIN VK 125 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN VK 125 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PENICILLIN VK 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN VK 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PENICILLIN VK 500 MG TABLET [Veetids] ![Compare how all Medicare Part D PDP plans in WI cover PENICILLIN VK 500 MG TABLET [Veetids].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PENTAM 300 INJ 300MG ![Compare how all Medicare Part D PDP plans in WI cover PENTAM 300 INJ 300MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent] ![Compare how all Medicare Part D PDP plans in WI cover PENTAMIDINE 300 MG INHAL POWDER VIAL-NEB [NebuPent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
PENTAMIDINE 300 MG VIAL [Pentam] ![Compare how all Medicare Part D PDP plans in WI cover PENTAMIDINE 300 MG VIAL [Pentam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENTASA 250MG CAPSULE SA ![Compare how all Medicare Part D PDP plans in WI cover PENTASA 250MG CAPSULE SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENTASA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PENTASA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PENTAZOCINE-NALOXONE TABLET [Talwin Nx] ![Compare how all Medicare Part D PDP plans in WI cover PENTAZOCINE-NALOXONE TABLET [Talwin Nx].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | Q:325 /30Days |
PENTOXIFYLLINE 400MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover PENTOXIFYLLINE 400MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PEPCID 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEPCID 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PEPCID 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEPCID 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PERCOCET 10/325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PERCOCET 10/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PERCOCET 2.5/325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PERCOCET 2.5/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERCOCET 5-325 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PERCOCET 5-325 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PERCOCET 7.5/325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PERCOCET 7.5/325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PERFOROMIST 20MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in WI cover PERFOROMIST 20MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PERINDOPRIL ERBUMINE 2 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERINDOPRIL ERBUMINE 2 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PERINDOPRIL ERBUMINE 4 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERINDOPRIL ERBUMINE 4 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PERINDOPRIL ERBUMINE 8 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERINDOPRIL ERBUMINE 8 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
Permethrin 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Permethrin 50mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PERPHEN-AMITRIP 2 MG-10 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERPHEN-AMITRIP 2 MG-10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PERPHEN-AMITRIP 2 MG-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERPHEN-AMITRIP 2 MG-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PERPHEN-AMITRIP 4 MG-25 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PERPHEN-AMITRIP 4 MG-25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PERPHENAZINE 16 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in WI cover PERPHENAZINE 16 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PERPHENAZINE 2 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in WI cover PERPHENAZINE 2 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PERPHENAZINE 4 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in WI cover PERPHENAZINE 4 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PERPHENAZINE 8 MG TABLET [Trilafon] ![Compare how all Medicare Part D PDP plans in WI cover PERPHENAZINE 8 MG TABLET [Trilafon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT ![Compare how all Medicare Part D PDP plans in WI cover PERSERIS ER 120 MG SYRINGE KIT SUSER SYKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | S |
PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT ![Compare how all Medicare Part D PDP plans in WI cover PERSERIS ER 90 MG SYRINGE KIT SUSER SYKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | S |
PERTZYE DR 16,000 UNITS CAPS ![Compare how all Medicare Part D PDP plans in WI cover PERTZYE DR 16,000 UNITS CAPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PERTZYE DR 24,000 UNIT CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover PERTZYE DR 24,000 UNIT CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PERTZYE DR 4,000 UNIT CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PERTZYE DR 4,000 UNIT CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PERTZYE DR 8,000 UNITS CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PERTZYE DR 8,000 UNITS CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PEXEVA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEXEVA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PEXEVA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEXEVA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PEXEVA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEXEVA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PEXEVA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PEXEVA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Phenelzine Sulfate 15mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Phenobarbital 100mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Phenobarbital 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 16.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 16.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 20 MG/5 ML ELIX ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 20 MG/5 ML ELIX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 32.4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 32.4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Phenobarbital 60mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Phenobarbital 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOBARBITAL 64.8 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 64.8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PHENOBARBITAL 97.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PHENOBARBITAL 97.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PHENOXYBENZAMINE HCL 10 MG CAPSULE [Dibenzyline] ![Compare how all Medicare Part D PDP plans in WI cover PHENOXYBENZAMINE HCL 10 MG CAPSULE [Dibenzyline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PHENYTEK 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PHENYTEK 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S |
PHENYTEK 300 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PHENYTEK 300 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S |
PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin] ![Compare how all Medicare Part D PDP plans in WI cover PHENYTOIN 125 MG/5 ML ORAL SUSPENSION [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin] ![Compare how all Medicare Part D PDP plans in WI cover PHENYTOIN 50 MG CHEWABLE TABLET [Dilantin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PHENYTOIN SOD EXT 100 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover PHENYTOIN SOD EXT 100 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PHENYTOIN SOD EXT 200 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover PHENYTOIN SOD EXT 200 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek] ![Compare how all Medicare Part D PDP plans in WI cover PHENYTOIN SOD EXT 300 MG CAPSULE [Phenytek].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Phoslyra 667mg/5mL 1 BOTTLE per CARTON / 473 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Phoslyra 667mg/5mL 1 BOTTLE per CARTON / 473 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PHOSPHOLINE IODIDE 0.125% 6.25MG ![Compare how all Medicare Part D PDP plans in WI cover PHOSPHOLINE IODIDE 0.125% 6.25MG .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PICATO 0.015% GEL ![Compare how all Medicare Part D PDP plans in WI cover PICATO 0.015% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PICATO 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover PICATO 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PIFELTRO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIFELTRO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PILOCARPINE 1% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in WI cover PILOCARPINE 1% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PILOCARPINE 2% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in WI cover PILOCARPINE 2% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PILOCARPINE 4% EYE DROPS [Pilocar] ![Compare how all Medicare Part D PDP plans in WI cover PILOCARPINE 4% EYE DROPS [Pilocar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PILOCARPINE HCL 5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in WI cover PILOCARPINE HCL 5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PILOCARPINE HCL 7.5 MG TABLET [Salagen] ![Compare how all Medicare Part D PDP plans in WI cover PILOCARPINE HCL 7.5 MG TABLET [Salagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIMECROLIMUS 1% CREAM (g) [Elidel] ![Compare how all Medicare Part D PDP plans in WI cover PIMECROLIMUS 1% CREAM (g) [Elidel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIMOZIDE 1 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in WI cover PIMOZIDE 1 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIMOZIDE 2 MG TABLET [Orap] ![Compare how all Medicare Part D PDP plans in WI cover PIMOZIDE 2 MG TABLET [Orap].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIMTREA 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIMTREA 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PINDOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PINDOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PINDOLOL 5 MG TABLET [Visken] ![Compare how all Medicare Part D PDP plans in WI cover PINDOLOL 5 MG TABLET [Visken].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIOGLITAZONE HCL 15 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE HCL 15 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:30 /30Days |
PIOGLITAZONE HCL 30 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE HCL 30 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:30 /30Days |
PIOGLITAZONE HCL 45 MG TABLET [Actos] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE HCL 45 MG TABLET [Actos].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:30 /30Days |
PIOGLITAZONE-GLIMEPIRIDE 30-2 TABLET [Duetact] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE-GLIMEPIRIDE 30-2 TABLET [Duetact].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:30 /30Days |
PIOGLITAZONE-GLIMEPIRIDE 30-4 Tablet [Duetact] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE-GLIMEPIRIDE 30-4 Tablet [Duetact].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:30 /30Days |
PIOGLITAZONE-METFORMIN 15-500 TABLET [Actoplus Met] ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE-METFORMIN 15-500 TABLET [Actoplus Met].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:90 /30Days |
PIOGLITAZONE-METFORMIN 15-850 ![Compare how all Medicare Part D PDP plans in WI cover PIOGLITAZONE-METFORMIN 15-850.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:90 /30Days |
PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in WI cover PIPERACIL-TAZOBACT 2.25 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in WI cover PIPERACIL-TAZOBACT 3.375 GM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PIPERACIL-TAZOBACT 4.5 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover PIPERACIL-TAZOBACT 4.5 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn] ![Compare how all Medicare Part D PDP plans in WI cover PIPERACIL-TAZOBACT 40.5 GRAM VIAL [Zosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PIQRAY 200 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIQRAY 200 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PIQRAY 250 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIQRAY 250 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PIQRAY 300 MG DAILY DOSE TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIQRAY 300 MG DAILY DOSE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PIRMELLA 1-35 28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover PIRMELLA 1-35 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIROXICAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PIROXICAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PIROXICAM 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PIROXICAM 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PLAQUENIL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PLAQUENIL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PLASMA-LYTE 148 IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PLASMA-LYTE 148 IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML; ![Compare how all Medicare Part D PDP plans in WI cover PLASMA-LYTE A PH 7.4 SOLUTION 37;368; MG/100ML;.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PLAVIX 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PLAVIX 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PLEGRIDY 125 MCG/0.5 ML PEN ![Compare how all Medicare Part D PDP plans in WI cover PLEGRIDY 125 MCG/0.5 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PLEGRIDY 125 MCG/0.5 ML SYRING ![Compare how all Medicare Part D PDP plans in WI cover PLEGRIDY 125 MCG/0.5 ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PLEGRIDY PEN INJ STARTER PACK ![Compare how all Medicare Part D PDP plans in WI cover PLEGRIDY PEN INJ STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PLEGRIDY SYRINGE STARTER PACK ![Compare how all Medicare Part D PDP plans in WI cover PLEGRIDY SYRINGE STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PLENVU POWDER PACKETS SQ ![Compare how all Medicare Part D PDP plans in WI cover PLENVU POWDER PACKETS SQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PLIAGLIS 7%-7% CREAM (g) ![Compare how all Medicare Part D PDP plans in WI cover PLIAGLIS 7%-7% CREAM (g).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PODOFILOX 0.5% TOPICAL TUBEX ![Compare how all Medicare Part D PDP plans in WI cover PODOFILOX 0.5% TOPICAL TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POLYMYXIN B SULFATE VIAL ![Compare how all Medicare Part D PDP plans in WI cover POLYMYXIN B SULFATE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POLYMYXIN B-TMP EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover POLYMYXIN B-TMP EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POLYTRIM EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover POLYTRIM EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
POMALYST 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover POMALYST 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:90 /30Days |
POMALYST 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover POMALYST 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:90 /30Days |
POMALYST 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover POMALYST 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:90 /30Days |
POMALYST 4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover POMALYST 4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:90 /30Days |
PORTIA 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in WI cover PORTIA 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POSACONAZOLE DR 100 MG TABLET [Noxafil] ![Compare how all Medicare Part D PDP plans in WI cover POSACONAZOLE DR 100 MG TABLET [Noxafil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Potassium Chloride 2 MEQ/ML Injectable Solution ![Compare how all Medicare Part D PDP plans in WI cover Potassium Chloride 2 MEQ/ML Injectable Solution.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Potassium Chloride 8 MEQ Extended Release Oral Tablet ![Compare how all Medicare Part D PDP plans in WI cover Potassium Chloride 8 MEQ Extended Release Oral Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG ![Compare how all Medicare Part D PDP plans in WI cover Potassium Chloride in Dextrose 5; 150g/100mL; mg/100mL 1000 mL in 1 BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i ![Compare how all Medicare Part D PDP plans in WI cover Potassium Chloride in Dextrose and Sodium Chloride 5; 300; 900g/100mL; mg/100mL; mg/100mL 1000 mL i.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CITRATE ER 10 MEQ TB ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CITRATE ER 10 MEQ TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CITRATE ER 15 MEQ TABLET ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CITRATE ER 15 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CITRATE ER 5 MEQ TAB ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CITRATE ER 5 MEQ TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 10 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 10% (20 MEQ/15ML) Liquid [Kay Ciel] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 10% (20 MEQ/15ML) Liquid [Kay Ciel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 20 MEQ PACKET [Klor-Con] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 20 MEQ PACKET [Klor-Con].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 20 MEQ-0.45% NACL IV SOLN ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 20 MEQ-0.45% NACL IV SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 20 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 20% (40 MEQ/15ML) Liquid [Kaon-CL] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 20% (40 MEQ/15ML) Liquid [Kaon-CL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 40 MEQ/100 ML SOL PIGGYBACK ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 40 MEQ/100 ML SOL PIGGYBACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL 40 MEQ/20 ML CONC VIAL [PROAMP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
POTASSIUM CL ER 10 MEQ CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL ER 10 MEQ CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL ER 10 MEQ TABLET ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL ER 10 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL ER 10 MEQ TABLET [Klotrix] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL ER 10 MEQ TABLET [Klotrix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Potassium cl er 20 meq tablet ![Compare how all Medicare Part D PDP plans in WI cover Potassium cl er 20 meq tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL ER 20 MEQ TABLET ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL ER 20 MEQ TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps] ![Compare how all Medicare Part D PDP plans in WI cover POTASSIUM CL ER 8 MEQ CAPSULE ER [Micro-K Extencaps].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRADAXA 110 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRADAXA 110 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PRADAXA 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRADAXA 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PRADAXA 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRADAXA 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PRALUENT 150 MG/ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover PRALUENT 150 MG/ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P Q:2 /28Days |
PRALUENT 75 MG/ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover PRALUENT 75 MG/ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAMIPEXOLE 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE 0.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 0.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE 1.5 MG TABLET [Mirapex] ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE 1.5 MG TABLET [Mirapex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE ER 0.375 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 0.375 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE ER 0.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 0.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE ER 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRAMIPEXOLE ER 2.25 MG TABLET ER 24H [Mirapex ER] ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 2.25 MG TABLET ER 24H [Mirapex ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE ER 3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAMIPEXOLE ER 3.75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 3.75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAMIPEXOLE ER 4.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAMIPEXOLE ER 4.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRASUGREL 10 MG TABLET [Effient] ![Compare how all Medicare Part D PDP plans in WI cover PRASUGREL 10 MG TABLET [Effient].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRASUGREL 5 MG TABLET [Effient] ![Compare how all Medicare Part D PDP plans in WI cover PRASUGREL 5 MG TABLET [Effient].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAVACHOL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAVACHOL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRAVACHOL 40MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRAVACHOL 40MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRAVASTATIN SODIUM 10 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in WI cover PRAVASTATIN SODIUM 10 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PRAVASTATIN SODIUM 20 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PRAVASTATIN SODIUM 20 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PRAVASTATIN SODIUM 40 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in WI cover PRAVASTATIN SODIUM 40 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PRAVASTATIN SODIUM 80 MG TABLET [Pravachol] ![Compare how all Medicare Part D PDP plans in WI cover PRAVASTATIN SODIUM 80 MG TABLET [Pravachol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PRAZIQUANTEL 600 MG TABLET [Biltricide] ![Compare how all Medicare Part D PDP plans in WI cover PRAZIQUANTEL 600 MG TABLET [Biltricide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRAZOSIN 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRAZOSIN 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAZOSIN 2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRAZOSIN 2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRAZOSIN 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PRAZOSIN 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRECOSE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRECOSE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:180 /30Days |
PRECOSE TABLETS 100MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover PRECOSE TABLETS 100MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:90 /30Days |
PRECOSE TABLETS 25MG 100 BOT ![Compare how all Medicare Part D PDP plans in WI cover PRECOSE TABLETS 25MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PRED FORTE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover PRED FORTE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in WI cover PRED G OPHTHALMIC SUSPENSION 1;0.3%;% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRED MILD 0.12% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover PRED MILD 0.12% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRED-G S.O.P. EYE OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover PRED-G S.O.P. EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Prednicarbate 0.1% cream ![Compare how all Medicare Part D PDP plans in WI cover Prednicarbate 0.1% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNICARBATE 0.1% OINTMENT [Dermatop] ![Compare how all Medicare Part D PDP plans in WI cover PREDNICARBATE 0.1% OINTMENT [Dermatop].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Prednisolone 10 mg/5 ml soln ![Compare how all Medicare Part D PDP plans in WI cover Prednisolone 10 mg/5 ml soln.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE 15 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE 15 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE 20 MG/5 ML SOLUTION [Veripred-20] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE 20 MG/5 ML SOLUTION [Veripred-20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE AC 1% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE AC 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE ODT 10 MG TABLET RAPDIS [Orapred ODT] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE ODT 10 MG TABLET RAPDIS [Orapred ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREDNISOLONE ODT 15 MG TABLET RAPDIS [Orapred ODT] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE ODT 15 MG TABLET RAPDIS [Orapred ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE ODT 30 MG TABLET RAPDIS [Orapred ODT] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE ODT 30 MG TABLET RAPDIS [Orapred ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE SOD 1% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE SOD 1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE SOD PH 25 MG/5 ML ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE SOD PH 25 MG/5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISOLONE SODIUM PHOSPHATE 5MG /5ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PREDNISOLONE SODIUM PHOSPHATE 5MG /5ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISONE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PREDNISONE 10 MG TABLET [Sterapred DS] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 10 MG TABLET [Sterapred DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 10 MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISONE 10 MG TABLET DOSE PACK ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 10 MG TABLET DOSE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISONE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PREDNISONE 20 MG TABLET [Predone] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 20 MG TABLET [Predone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISONE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISONE 5 MG TABLET [Sterapred] ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 5 MG TABLET [Sterapred].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
PREDNISONE 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREDNISONE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Tier 1 |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREDNISONE 5MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PREDNISONE 5MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Prefest 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Prefest 6 POUCH per CARTON / 1 BLISTER PACK in 1 POUCH / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PREGABALIN 100 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 100 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
PREGABALIN 150 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 150 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
PREGABALIN 20 MG/ML SOLUTION [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 20 MG/ML SOLUTION [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:900 /30Days |
PREGABALIN 200 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 200 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
PREGABALIN 225 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 225 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:60 /30Days |
PREGABALIN 25 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 25 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
PREGABALIN 300 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 300 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:60 /30Days |
PREGABALIN 50 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 50 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
PREGABALIN 75 MG CAPSULE [Lyrica] ![Compare how all Medicare Part D PDP plans in WI cover PREGABALIN 75 MG CAPSULE [Lyrica].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREMARIN 0.3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMARIN 0.3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PREMARIN 0.45MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMARIN 0.45MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PREMARIN 0.625 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMARIN 0.625 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
Premarin 0.625mg/g ![Compare how all Medicare Part D PDP plans in WI cover Premarin 0.625mg/g.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREMARIN 0.9MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMARIN 0.9MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PREMARIN 1.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMARIN 1.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PREMASOL 10% IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PREMASOL 10% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | P |
PREMPHASE 0.625-5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMPHASE 0.625-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREMPRO 0.3 MG-1.5 MG TABLET #28 EA ![Compare how all Medicare Part D PDP plans in WI cover PREMPRO 0.3 MG-1.5 MG TABLET #28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREMPRO 0.45-1.5 MG TABLET 28 EA ![Compare how all Medicare Part D PDP plans in WI cover PREMPRO 0.45-1.5 MG TABLET 28 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREMPRO 0.625-5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREMPRO 0.625-5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Prempro 0.625; 2.5mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, SUGAR COATED per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Prempro 0.625; 2.5mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, SUGAR COATED per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRETOMANID 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRETOMANID 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREVACID CAPSULES DELAYED RELEASE 15 MG ![Compare how all Medicare Part D PDP plans in WI cover PREVACID CAPSULES DELAYED RELEASE 15 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREVACID CAPSULES DELAYED RELEASE 30 MG ![Compare how all Medicare Part D PDP plans in WI cover PREVACID CAPSULES DELAYED RELEASE 30 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover PREVACID SOLUTAB EXTENDED RELEASE ORALLY DISINTEGRATING 30MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREVACID SOLUTAB TABLET DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover PREVACID SOLUTAB TABLET DELAYED RELEASE ORALLY DISINTEGRATING 15MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREVALITE PACKET ![Compare how all Medicare Part D PDP plans in WI cover PREVALITE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREVIFEM TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in WI cover PREVIFEM TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PREVYMIS 240 MG ![Compare how all Medicare Part D PDP plans in WI cover PREVYMIS 240 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PREVYMIS 480 MG ![Compare how all Medicare Part D PDP plans in WI cover PREVYMIS 480 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PREZCOBIX 800 MG-150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREZCOBIX 800 MG-150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PREZISTA 100 MG/ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover PREZISTA 100 MG/ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PREZISTA 150MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover PREZISTA 150MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PREZISTA 800 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PREZISTA 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PREZISTA TABLET 600MG ![Compare how all Medicare Part D PDP plans in WI cover PREZISTA TABLET 600MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PREZISTA TABLET 75MG ![Compare how all Medicare Part D PDP plans in WI cover PREZISTA TABLET 75MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRIFTIN 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRIFTIN 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PRILOSEC DR 10 MG SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover PRILOSEC DR 10 MG SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PRILOSEC DR 2.5 MG SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover PRILOSEC DR 2.5 MG SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
Primaquine Phosphate 26.3 MG Oral Tablet ![Compare how all Medicare Part D PDP plans in WI cover Primaquine Phosphate 26.3 MG Oral Tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS ![Compare how all Medicare Part D PDP plans in WI cover PRIMAXIN IV 500; 500mg/100mL; mg/100mL 25 VIAL, SINGLE-DOSE in 1 TRAY / 100 mL in 1 VIAL, SINGLE-DOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRIMIDONE 250 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in WI cover PRIMIDONE 250 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PRIMIDONE 50 MG TABLET [Mysoline] ![Compare how all Medicare Part D PDP plans in WI cover PRIMIDONE 50 MG TABLET [Mysoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PRIMLEV 10-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRIMLEV 10-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PRIMLEV 5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRIMLEV 5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PRIMLEV 7.5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRIMLEV 7.5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PRINIVIL 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRINIVIL 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRINIVIL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRINIVIL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRISTIQ 100MG TABLET SR 24HR ![Compare how all Medicare Part D PDP plans in WI cover PRISTIQ 100MG TABLET SR 24HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRISTIQ ER 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PRISTIQ ER 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRISTIQ ER 50 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover PRISTIQ ER 50 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRIVIGEN 10% VIAL ![Compare how all Medicare Part D PDP plans in WI cover PRIVIGEN 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROAIR HFA 90 MCG INHALER ![Compare how all Medicare Part D PDP plans in WI cover PROAIR HFA 90 MCG INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | Q:17 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROAIR RESPICLICK INHAL POWDER ![Compare how all Medicare Part D PDP plans in WI cover PROAIR RESPICLICK INHAL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | Q:2 /30Days |
PROBENECID 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROBENECID 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROBENECID-COLCHICINE TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROBENECID-COLCHICINE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0 ![Compare how all Medicare Part D PDP plans in WI cover ProcalAmine 0.21; 0.29; 0.026; 0.014; 3; 0.42; 0.085; 0.21; 0.27; 0.22; 0.054; 0.16; 0.17; 0.041; 0.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
PROCARDIA XL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROCARDIA XL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROCARDIA XL 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROCARDIA XL 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROCARDIA XL 90MG TABLET SA ![Compare how all Medicare Part D PDP plans in WI cover PROCARDIA XL 90MG TABLET SA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROCENTRA 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover PROCENTRA 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCHLORPERAZINE 10 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PROCHLORPERAZINE 10 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCHLORPERAZINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROCHLORPERAZINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in WI cover PROCHLORPERAZINE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCRIT 10000U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT 10000U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P Q:12 /28Days |
PROCRIT 2000U/ML VIAL 6 X 1ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT 2000U/ML VIAL 6 X 1ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P Q:12 /28Days |
PROCRIT 3,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT 3,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P Q:12 /28Days |
PROCRIT 4,000 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT 4,000 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P Q:12 /28Days |
PROCRIT 40000U/ML VIAL PR ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT 40000U/ML VIAL PR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY ![Compare how all Medicare Part D PDP plans in WI cover PROCRIT SOLUTION FOR INJECTION 20000UNT/ML 24 X 1 ML TRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROCTO-MED HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover PROCTO-MED HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
procto-pak 1% cream ![Compare how all Medicare Part D PDP plans in WI cover procto-pak 1% cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCTOSOL-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover PROCTOSOL-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCTOZONE-HC 2.5% CREAM ![Compare how all Medicare Part D PDP plans in WI cover PROCTOZONE-HC 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROCYSBI DR 300 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in WI cover PROCYSBI DR 300 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROCYSBI DR 75 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in WI cover PROCYSBI DR 75 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PROGESTERONE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROGESTERONE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROGESTERONE 200 MG CAPSULE [Prometrium] ![Compare how all Medicare Part D PDP plans in WI cover PROGESTERONE 200 MG CAPSULE [Prometrium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROGLYCEM 50 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover PROGLYCEM 50 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROGRAF 0.2 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in WI cover PROGRAF 0.2 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROGRAF 0.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROGRAF 0.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROGRAF 1 MG GRANULE PACKET ![Compare how all Medicare Part D PDP plans in WI cover PROGRAF 1 MG GRANULE PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROGRAF 1MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROGRAF 1MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROGRAF 5 MG 1 BOTTLE per CARTON / 100 CAPSULE, GELATIN COATED in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover PROGRAF 5 MG 1 BOTTLE per CARTON / 100 CAPSULE, GELATIN COATED in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROLASTIN C 1,000 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROLASTIN C 1,000 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PROLATE 10-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROLATE 10-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROLATE 5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROLATE 5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PROLATE 7.5-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROLATE 7.5-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:360 /30Days |
PROLENSA 0.07% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover PROLENSA 0.07% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROLIA 60MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in WI cover PROLIA 60MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | S |
PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 12.5 MG SUSPEN PACKET POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMACTA 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMACTA 25 MG SUSPENSION POWDER PACK ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 25 MG SUSPENSION POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMACTA 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMACTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMACTA 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMACTA 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROMETHAZINE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROMETHAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
PROMETHAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain] ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE 6.25 MG/5 ML SYRUP [Prometh Plain].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | P |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 12.5MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX ![Compare how all Medicare Part D PDP plans in WI cover PROMETHAZINE HYDROCHLORIDE SUPPOSITORIES 25MG 12 BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROMETHEGAN 25MG SUPP ![Compare how all Medicare Part D PDP plans in WI cover PROMETHEGAN 25MG SUPP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROMETHEGAN 50MG SUPPOS ![Compare how all Medicare Part D PDP plans in WI cover PROMETHEGAN 50MG SUPPOS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROMETRIUM 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROMETRIUM 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROMETRIUM 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROMETRIUM 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROPAFENONE HCL 150 MG TABLET [Rythmol] ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HCL 150 MG TABLET [Rythmol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPAFENONE HCL 225MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HCL 225MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPAFENONE HCL 300 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HCL 300 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPAFENONE HCL ER 225 MG CAP ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HCL ER 225 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HYDROCHLORIDE 325MG CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover PROPAFENONE HYDROCHLORIDE 425MG CAPSULES EXTENDED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in WI cover Propantheline Bromide 15mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROPRANOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL 20MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 20MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL 40MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 40MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROPRANOLOL 80 MG TABLET [Inderal] ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL 80 MG TABLET [Inderal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL ER 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL ER 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL ER 160 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL ER 160 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL ER 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL ER 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL ER 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL ER 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL/HCTZ 40/25 TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL/HCTZ 40/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPRANOLOL/HCTZ 80/25 TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPRANOLOL/HCTZ 80/25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROPYLTHIOURACIL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROPYLTHIOURACIL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROQUAD VIAL ![Compare how all Medicare Part D PDP plans in WI cover PROQUAD VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Tier 3 |
$42.00 | $105.00 | None |
PROSCAR TABLETS 5MG 30 BOT ![Compare how all Medicare Part D PDP plans in WI cover PROSCAR TABLETS 5MG 30 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROSOL 20% INJECTION ![Compare how all Medicare Part D PDP plans in WI cover PROSOL 20% INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROTONIX 20MG TABLET EC ![Compare how all Medicare Part D PDP plans in WI cover PROTONIX 20MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROTONIX 40MG SUSP FOR RECON DELAYED REL. IN A PACKET ![Compare how all Medicare Part D PDP plans in WI cover PROTONIX 40MG SUSP FOR RECON DELAYED REL. IN A PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PROTONIX 40MG TABLET EC ![Compare how all Medicare Part D PDP plans in WI cover PROTONIX 40MG TABLET EC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROTOPIC 0.03% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover PROTOPIC 0.03% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROTOPIC 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover PROTOPIC 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROTRIPTYLINE HCL 10 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in WI cover PROTRIPTYLINE HCL 10 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROTRIPTYLINE HCL 5 MG TABLET [Vivactil] ![Compare how all Medicare Part D PDP plans in WI cover PROTRIPTYLINE HCL 5 MG TABLET [Vivactil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PROVENTIL HFA 90 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover PROVENTIL HFA 90 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:13 /30Days |
PROVERA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROVERA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROVERA 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROVERA 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROVERA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROVERA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PROVIGIL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROVIGIL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROVIGIL 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PROVIGIL 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
PROZAC 10MG PULVULE ![Compare how all Medicare Part D PDP plans in WI cover PROZAC 10MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROZAC 20 MG PULVULE CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PROZAC 20 MG PULVULE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PROZAC 40MG PULVULE ![Compare how all Medicare Part D PDP plans in WI cover PROZAC 40MG PULVULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PRUDOXIN 5% CREAM (g) [Zonalon] ![Compare how all Medicare Part D PDP plans in WI cover PRUDOXIN 5% CREAM (g) [Zonalon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PSORCON 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover PSORCON 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:120 /30Days |
PULMICORT .25MG/2ML RESPULE ![Compare how all Medicare Part D PDP plans in WI cover PULMICORT .25MG/2ML RESPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION ![Compare how all Medicare Part D PDP plans in WI cover PULMICORT 1MG/2ML AMPUL FOR NEBULIZATION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in WI cover PULMICORT FLEXHALER 180MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:1 /30Days |
PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED ![Compare how all Medicare Part D PDP plans in WI cover PULMICORT FLEXHALER 90MCG AEROSOL POWDER BREATH ACTIVATED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | Q:1 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
PULMICORT RESPULES 0.5mg/2mL 6 POUCH per CARTON / 5 AMPULE in 1 POUCH / 2 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in WI cover PULMICORT RESPULES 0.5mg/2mL 6 POUCH per CARTON / 5 AMPULE in 1 POUCH / 2 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | P |
PULMOZYME 1MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover PULMOZYME 1MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:150 /30Days |
PURIXAN 20 MG/ML ORAL SUSP ![Compare how all Medicare Part D PDP plans in WI cover PURIXAN 20 MG/ML ORAL SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PYLERA CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover PYLERA CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PYRAZINAMIDE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PYRAZINAMIDE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PYRIDOSTIGMINE 60 MG/5 ML SOLN SYRUP [Mestinon] ![Compare how all Medicare Part D PDP plans in WI cover PYRIDOSTIGMINE 60 MG/5 ML SOLN SYRUP [Mestinon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
PYRIDOSTIGMINE BR 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PYRIDOSTIGMINE BR 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 |
$84.00 | $210.00 | None |
PYRIDOSTIGMINE BR 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover PYRIDOSTIGMINE BR 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PYRIDOSTIGMINE BR ER 180 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover PYRIDOSTIGMINE BR ER 180 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Tier 2 |
$8.00 | $20.00 | None |
PYRIMETHAMINE 25 MG TABLET [Daraprim] ![Compare how all Medicare Part D PDP plans in WI cover PYRIMETHAMINE 25 MG TABLET [Daraprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |