2021 Medicare Part D Plan Formulary Information |
Network PlatinumPremier Pharmacy (PPO) (H5215-005-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Network PlatinumPremier Pharmacy (PPO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) |
The Network PlatinumPremier Pharmacy (PPO) (H5215-005-0) Formulary Drugs Starting with the Letter B in Outagamie County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $297.00 Deductible: $260 |
Drugs Starting with Letter B
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Bacitracin 500 unit/gm Eye Ointment ![Compare how all Medicare Part D PDP plans in WI cover Bacitracin 500 unit/gm Eye Ointment.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT ![Compare how all Medicare Part D PDP plans in WI cover BACITRACIN/POLYMYXIN B OINT 500UNT/10000UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BACLOFEN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BACLOFEN 20 MG TABLET [Lioresal] ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 20 MG TABLET [Lioresal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BACLOFEN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACLOFEN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BACTRIM 400-80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM 400-80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BACTRIM DS 800-160 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BACTRIM DS 800-160 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BAFIERTAM DR 95 MG CAPSULE DR ![Compare how all Medicare Part D PDP plans in WI cover BAFIERTAM DR 95 MG CAPSULE DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:120 /30Days |
BALCOLTRA TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALCOLTRA TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal] ![Compare how all Medicare Part D PDP plans in WI cover BALSALAZIDE DISODIUM 750 MG CAPSULE [Colazal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BALVERSA 3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALVERSA 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BALVERSA 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALVERSA 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BALVERSA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BALVERSA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Balziva 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 Balziva 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) |
2* |
Generic |
$8.00 | $20.00 | None |
Banzel 200mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Banzel 200mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S |
BANZEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BANZEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S |
Banzel 40mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Banzel 40mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S |
BAQSIMI 3 MG SPRAY TWO PACK ![Compare how all Medicare Part D PDP plans in WI cover BAQSIMI 3 MG SPRAY TWO PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.05mg/mL 1 BOTTLE per CARTON / 210 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BARACLUDE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BARACLUDE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BARACLUDE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BASAGLAR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover BASAGLAR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
BAXDELA 300 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover BAXDELA 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BAXDELA 450 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BAXDELA 450 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL ![Compare how all Medicare Part D PDP plans in WI cover BCG VACCINE 50mg/1 1 VIAL per CARTON / 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BECONASE AQ 0.042% SPRAY ![Compare how all Medicare Part D PDP plans in WI cover BECONASE AQ 0.042% SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S Q:50 /30Days |
BELBUCA 150 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 150 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
BELBUCA 300 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 300 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
BELBUCA 450 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 450 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
BELBUCA 600 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 600 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
BELBUCA 75 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 75 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
BELBUCA 750 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 750 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BELBUCA 900 MCG FILM ![Compare how all Medicare Part D PDP plans in WI cover BELBUCA 900 MCG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
BELSOMRA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BELSOMRA 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BELSOMRA 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BELSOMRA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BELSOMRA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENAZEPRIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BENAZEPRIL HCL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BENAZEPRIL HCL 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BENAZEPRIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL-HCTZ 10-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL-HCTZ 20-12.5 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL-HCTZ 20-25 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BENAZEPRIL-HCTZ 5-6.25 MG TABLET [Lotensin HCT] ![Compare how all Medicare Part D PDP plans in WI cover BENAZEPRIL-HCTZ 5-6.25 MG TABLET [Lotensin HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BENICAR 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENICAR 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENICAR 5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENICAR HCT 20-12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 20-12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENICAR HCT 40-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT 40-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENICAR HCT TABLET 12.5-40MG (30 CT) ![Compare how all Medicare Part D PDP plans in WI cover BENICAR HCT TABLET 12.5-40MG (30 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENLYSTA 200 MG/ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BENLYSTA 200 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BENLYSTA 200 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BENZACLIN GEL 50G PUMP ![Compare how all Medicare Part D PDP plans in WI cover BENZACLIN GEL 50G PUMP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BENZAMYCIN GEL ![Compare how all Medicare Part D PDP plans in WI cover BENZAMYCIN GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BENZNIDAZOLE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BENZNIDAZOLE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BENZNIDAZOLE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BENZTROPINE MES 0.5 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 0.5 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BENZTROPINE MES 1 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 1 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BENZTROPINE MES 2 MG TABLET [Cogentin] ![Compare how all Medicare Part D PDP plans in WI cover BENZTROPINE MES 2 MG TABLET [Cogentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BEPREVE 1.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BEPREVE 1.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BERINERT 500 UNIT KIT ![Compare how all Medicare Part D PDP plans in WI cover BERINERT 500 UNIT KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BESER 0.05% LOTION [Cutivate] ![Compare how all Medicare Part D PDP plans in WI cover BESER 0.05% LOTION [Cutivate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR ![Compare how all Medicare Part D PDP plans in WI cover BESIVANCE BESIFLOACIN OPTHALMIC SUSPENSION 0.6% 5 ML BOTDR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Betamethasone Dipropionate 0.64mg/g / 45 g TUBE ![Compare how all Medicare Part D PDP plans in WI cover Betamethasone Dipropionate 0.64mg/g / 45 g TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAMETHASONE DP 0.05% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE DP 0.05% OINTMENT [Maxivate] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP 0.05% OINTMENT [Maxivate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% CREAM (g) [RRB Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE DP AUG 0.05% GEL ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE DP AUG 0.05% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE DP AUG 0.05% OINTMENT [Diprolene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE VA 0.1% CREAM (G) [Valisone] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VA 0.1% CREAM (G) [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE VALER 0.1% LOTION [Valisone] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALER 0.1% LOTION [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE VALER 0.1% OINTMENT [Valisone] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALER 0.1% OINTMENT [Valisone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAMETHASONE VALER 0.12% FOAM [Luxiq Foam] ![Compare how all Medicare Part D PDP plans in WI cover BETAMETHASONE VALER 0.12% FOAM [Luxiq Foam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BETAPACE AF 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETAPACE AF 160 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 160 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BETAPACE AF 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAPACE AF 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BETASERON 0.3 MG KIT ![Compare how all Medicare Part D PDP plans in WI cover BETASERON 0.3 MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BETAXOLOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAXOLOL 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETAXOLOL HCL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETAXOLOL HCL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETHANECHOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETHANECHOL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETHANECHOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETHANECHOL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BETHANECHOL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BETHKIS 300 MG/4 ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover BETHKIS 300 MG/4 ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:224 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BETIMOL 0.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S |
BETIMOL 0.5% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BETIMOL 0.5% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S |
BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT ![Compare how all Medicare Part D PDP plans in WI cover BETOPTIC S OPHTHALMIC SUSPENSION 0.25% 10 ML BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S |
BEVESPI AEROSPHERE INHALER ![Compare how all Medicare Part D PDP plans in WI cover BEVESPI AEROSPHERE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:11 /30Days |
BEXAROTENE 75 MG CAPSULE [Targretin] ![Compare how all Medicare Part D PDP plans in WI cover BEXAROTENE 75 MG CAPSULE [Targretin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BEXSERO PREFILLED SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BEXSERO PREFILLED SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Beyaz 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Beyaz 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BICALUTAMIDE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BICALUTAMIDE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BICILL LA PFS 600MU 1ML PED ![Compare how all Medicare Part D PDP plans in WI cover BICILL LA PFS 600MU 1ML PED.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BICILLIN C-R 1.2MM UNITS SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 1.2MM UNITS SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BICILLIN C-R 900/300 SYRINGE 2ML x 10 ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN C-R 900/300 SYRINGE 2ML x 10.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BICILLIN LA PFS 1200MU 2ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA PFS 1200MU 2ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BICILLIN LA. 600000UNIT/ML 1ML ![Compare how all Medicare Part D PDP plans in WI cover BICILLIN LA. 600000UNIT/ML 1ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BIDIL TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIDIL TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BIJUVA 1 MG-100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BIJUVA 1 MG-100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BIKTARVY 50-200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BIKTARVY 50-200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Biltricide 600mg/1 6 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BIMATOPROST 0.03% EYE DROPS [Lumigan] ![Compare how all Medicare Part D PDP plans in WI cover BIMATOPROST 0.03% EYE DROPS [Lumigan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BINOSTO 70 MG EFFERVESCENT TABLET ![Compare how all Medicare Part D PDP plans in WI cover BINOSTO 70 MG EFFERVESCENT TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S Q:5 /30Days |
BISOPROLOL FUMARATE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BISOPROLOL FUMARATE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL FUMARATE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BISOPROLOL-HCTZ 10-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 10-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BISOPROLOL-HCTZ 2.5-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 2.5-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BISOPROLOL-HCTZ 5-6.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BISOPROLOL-HCTZ 5-6.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BIVIGAM 10% VIAL [Panzyga] ![Compare how all Medicare Part D PDP plans in WI cover BIVIGAM 10% VIAL [Panzyga].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BLEPH-10 10% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPH-10 10% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BLEPHAMIDE 10-0.2% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE 10-0.2% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BLEPHAMIDE EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BLEPHAMIDE EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BLISOVI 24 FE TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI 24 FE TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30] ![Compare how all Medicare Part D PDP plans in WI cover BLISOVI FE 1.5-30 TABLET [Microgestin Fe 1.5/30].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BONIVA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BONIVA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S Q:1 /30Days |
BONJESTA ER 20-20 MG TABLET IR DR ![Compare how all Medicare Part D PDP plans in WI cover BONJESTA ER 20-20 MG TABLET IR DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BOOSTRIX TDAP VACCINE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BOOSTRIX TDAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover BOOSTRIX TDAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BOSENTAN 125 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in WI cover BOSENTAN 125 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
BOSENTAN 62.5 MG TABLET [Tracleer] ![Compare how all Medicare Part D PDP plans in WI cover BOSENTAN 62.5 MG TABLET [Tracleer].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
BOSULIF 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:180 /30Days |
BOSULIF 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
BOSULIF 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BOSULIF 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
BRAFTOVI 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BRAFTOVI 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BREO ELLIPTA 100-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 100-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
BREO ELLIPTA 200-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover BREO ELLIPTA 200-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
BREZTRI AEROSPHERE INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover BREZTRI AEROSPHERE INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:11 /30Days |
BRIELLYN TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIELLYN TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRILINTA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BRILINTA 90mg/1 60 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BRILINTA 90mg/1 60 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BRIMONIDINE 0.2% EYE DROPS [Alphagan] ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE 0.2% EYE DROPS [Alphagan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BRIMONIDINE TARTRATE 0.15% DROPS ![Compare how all Medicare Part D PDP plans in WI cover BRIMONIDINE TARTRATE 0.15% DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BRINZOLAMIDE 1% EYE DROPS EYE DROPPER [Azopt] ![Compare how all Medicare Part D PDP plans in WI cover BRINZOLAMIDE 1% EYE DROPS EYE DROPPER [Azopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
BRISDELLE 7.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BRISDELLE 7.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BRIVIACT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:60 /30Days |
BRIVIACT 10 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 10 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:600 /30Days |
BRIVIACT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:60 /30Days |
BRIVIACT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:60 /30Days |
BRIVIACT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BRIVIACT 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BRIVIACT 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:60 /30Days |
BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom] ![Compare how all Medicare Part D PDP plans in WI cover BROMFENAC SODIUM 0.09% EYE DROPS [Xibrom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BROMOCRIPTINE 2.5 MG TABLET [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE 2.5 MG TABLET [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BROMOCRIPTINE 5 MG CAPSULE [Parlodel] ![Compare how all Medicare Part D PDP plans in WI cover BROMOCRIPTINE 5 MG CAPSULE [Parlodel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BROMSITE 0.075% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover BROMSITE 0.075% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BRONCHITOL 40 MG INHALE CAPSULE W/DEV ![Compare how all Medicare Part D PDP plans in WI cover BRONCHITOL 40 MG INHALE CAPSULE W/DEV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BROVANA 15MCG/2ML VIAL NEBULIZER ![Compare how all Medicare Part D PDP plans in WI cover BROVANA 15MCG/2ML VIAL NEBULIZER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:120 /30Days |
BRUKINSA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BRUKINSA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
BRYHALI 0.01% LOTION ![Compare how all Medicare Part D PDP plans in WI cover BRYHALI 0.01% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.25 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | P |
BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 0.5 MG/2 ML SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE 1 MG/2 ML INH SUSP AMPUL-NEB [Pulmicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | P |
BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE EC 3 MG CAPSULE DR - ER [Entocort EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BUDESONIDE ER 9 MG TABLETDR - ER [UCERIS] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE ER 9 MG TABLETDR - ER [UCERIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BUDESONIDE-FORMOTEROL 160-4.5 HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE-FORMOTEROL 160-4.5 HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:10 /30Days |
BUDESONIDE-FORMOTEROL 80-4.5 HFA AER AD [Symbicort] ![Compare how all Medicare Part D PDP plans in WI cover BUDESONIDE-FORMOTEROL 80-4.5 HFA AER AD [Symbicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:10 /30Days |
BUMETANIDE 0.5 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 0.5 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUMETANIDE 1 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 1 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUMETANIDE 1 MG/4 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 1 MG/4 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUMETANIDE 2 MG TABLET [Bumex] ![Compare how all Medicare Part D PDP plans in WI cover BUMETANIDE 2 MG TABLET [Bumex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPAP 50 MG-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPAP 50 MG-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:360 /30Days |
BUPHENYL 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPHENYL POWDER ![Compare how all Medicare Part D PDP plans in WI cover BUPHENYL POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORP-NALOX 12-3 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:60 /30Days |
BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORP-NALOX 2-0.5 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:360 /30Days |
BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORP-NALOX 4-1 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:90 /30Days |
BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORP-NALOX 8-2 MG SL FILM [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:90 /30Days |
BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHIN-NALOXON 8-2 MG SL SUSLIGUAL TABLET [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:90 /30Days |
BUPRENORPHINE 10 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 10 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
BUPRENORPHINE 15 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 15 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 2 MG TABLET SUSLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPRENORPHINE 20 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 20 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
BUPRENORPHINE 5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 7.5 MCG/HR PATCH [Butrans].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /28Days |
BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHINE 8 MG TABLET SUSLIGUAL [Subutex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone] ![Compare how all Medicare Part D PDP plans in WI cover BUPRENORPHN-NALOXN 2-0.5 MG TABLET SUSLIGUAL [Suboxone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:360 /30Days |
BUPROPION HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPROPION HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 100 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BUPROPION HCL SR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR] ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 150 MG TABLET SR 12H [Wellbutrin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BUPROPION HCL SR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL SR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
BUPROPION HCL XL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUPROPION HCL XL 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUPROPION HCL XL 450 MG TABLET ER 24H [Forfivo XL] ![Compare how all Medicare Part D PDP plans in WI cover BUPROPION HCL XL 450 MG TABLET ER 24H [Forfivo XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BUSPIRONE HCL 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUSPIRONE HCL 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUSPIRONE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUSPIRONE HCL 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HCL 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUSPIRONE HYDROCHLORIDE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BUSPIRONE HYDROCHLORIDE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
BUTALB-ACETAMIN-CAFF 50-300-40 CAPSULE [Phrenilin Forte] ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-ACETAMIN-CAFF 50-300-40 CAPSULE [Phrenilin Forte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALB-ACETAMIN-CAFF 50-325-40 TABLET [Repan] ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-ACETAMIN-CAFF 50-325-40 TABLET [Repan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALB-CAFF-ACETAMINOPH-CODEIN ![Compare how all Medicare Part D PDP plans in WI cover BUTALB-CAFF-ACETAMINOPH-CODEIN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL COMP-CODEINE #3 CAPSULE [Fiorinal with Codeine] ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL COMP-CODEINE #3 CAPSULE [Fiorinal with Codeine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL-ACETAMINOPHN 25-325 TABLET [Allzital] ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ACETAMINOPHN 25-325 TABLET [Allzital].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BUTALBITAL-ACETAMINOPHN 50-300 CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ACETAMINOPHN 50-300 CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL-ACETAMINOPHN 50-300 TABLET [ORBIVAN CF] ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ACETAMINOPHN 50-300 TABLET [ORBIVAN CF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL-ASA-CAFFEINE CAPSULE [Fiorinal] ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL-ASA-CAFFEINE CAPSULE [Fiorinal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN 325; 50mg/1; mg/1 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTALBITAL/ACETAMINOPHEN/CAFFEINE CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover BUTALBITAL/ACETAMINOPHEN/CAFFEINE CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
BUTORPHANOL 10 MG/ML SPRAY [Stadol NS] ![Compare how all Medicare Part D PDP plans in WI cover BUTORPHANOL 10 MG/ML SPRAY [Stadol NS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:5 /28Days |
Butrans 10ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 10ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:4 /28Days |
BUTRANS 15 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover BUTRANS 15 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:4 /28Days |
Butrans 20ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 20ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:4 /28Days |
Butrans 5ug/h ![Compare how all Medicare Part D PDP plans in WI cover Butrans 5ug/h.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:4 /28Days |
BUTRANS 7.5 MCG/HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover BUTRANS 7.5 MCG/HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:4 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
BYDUREON BCISE 2 MG AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover BYDUREON BCISE 2 MG AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | S Q:4 /28Days |
BYETTA 10 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 10 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | S Q:2 /30Days |
BYETTA 5 MCG DOSE PEN INJ ![Compare how all Medicare Part D PDP plans in WI cover BYETTA 5 MCG DOSE PEN INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | S Q:1 /30Days |
Bystolic 10mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 10mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Bystolic 2.5mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 2.5mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
BYSTOLIC 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover BYSTOLIC 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Bystolic 5mg 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Bystolic 5mg 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |