2021 Medicare Part D Plan Formulary Information |
Network PlatinumPremier Pharmacy (PPO) (H5215-005-0)
Benefit Details
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The Network PlatinumPremier Pharmacy (PPO) (H5215-005-0) Formulary Drugs Starting with the Letter H in Portage County, WI: CMS MA Region 14 which includes: WI Plan Monthly Premium: $297.00 Deductible: $260 |
Drugs Starting with Letter H
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
HAEGARDA 2,000 UNIT VIAL ![Compare how all Medicare Part D PDP plans in WI cover HAEGARDA 2,000 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HAEGARDA 3,000 UNIT VIAL ![Compare how all Medicare Part D PDP plans in WI cover HAEGARDA 3,000 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HAILEY 24 FE 1 MG-20 MCG TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in WI cover HAILEY 24 FE 1 MG-20 MCG TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALCINONIDE 0.1% CREAM (g) [Halog -E] ![Compare how all Medicare Part D PDP plans in WI cover HALCINONIDE 0.1% CREAM (g) [Halog -E].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HALCION 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HALCION 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALDOL 5MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HALDOL 5MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALDOL DECANOATE 100MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HALDOL DECANOATE 100MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALDOL DECANOATE 50MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HALDOL DECANOATE 50MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALOBETASOL PROP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in WI cover HALOBETASOL PROP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE.](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 |
HALOG 0.1% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover HALOG 0.1% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Halog 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG] ![Compare how all Medicare Part D PDP plans in WI cover HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HALOPERIDOL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL 1 MG TABLET [Haldol] ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 1 MG TABLET [Haldol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL 5 MG TABLET [Haldol] ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL 5 MG TABLET [Haldol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL DEC 100 MG/ML AMPUL [Haldol Decanoate] ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL DEC 100 MG/ML AMPUL [Haldol Decanoate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL DEC 100 MG/ML VIAL.](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 |
HALOPERIDOL DEC 250 MG/5 ML VIAL [Haldol Decanoate] ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL DEC 250 MG/5 ML VIAL [Haldol Decanoate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL DECAN 50 MG/ML AMPUL [Haldol Decanoate] ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL DECAN 50 MG/ML AMPUL [Haldol Decanoate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL LAC 2 MG/ML CONC ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL LAC 2 MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HALOPERIDOL LAC 5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HALOPERIDOL LAC 5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HARVONI 33.75-150 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in WI cover HARVONI 33.75-150 MG PELLET PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
HARVONI 45-200 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in WI cover HARVONI 45-200 MG PELLET PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:56 /28Days |
HARVONI 90-400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HARVONI 90-400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
HAVRIX 1,440 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover HAVRIX 1,440 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HAVRIX HEPATITIS A VACCINE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HELIDAC THERAPY PACK COMBO PKG ![Compare how all Medicare Part D PDP plans in WI cover HELIDAC THERAPY PACK COMBO PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HEMADY 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HEMADY 20 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 |
HEPARIN 30,000 UNIT/30 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HEPARIN 30,000 UNIT/30 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HEPARIN SOD 5,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HEPARIN SOD 5,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in WI cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
Hepatitis B Surface Antigen Vaccine 0.01 MG/ML Prefilled 0.5 ML Syringe [Recombivax] ![Compare how all Medicare Part D PDP plans in WI cover Hepatitis B Surface Antigen Vaccine 0.01 MG/ML Prefilled 0.5 ML Syringe [Recombivax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
HEPSERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
HETLIOZ 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HETLIOZ 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
HETLIOZ LQ 4 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover HETLIOZ LQ 4 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:158 /30Days |
HIBERIX VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in WI cover HIBERIX VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HIPREX 1 GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover HIPREX 1 GM 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 |
HORIZANT ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HORIZANT ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S |
HORIZANT ER 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HORIZANT ER 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | S |
HUMALOG 100 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG 100 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG 100 UNITS/ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG 100 UNITS/ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG 200 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG 200 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG JR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG JR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG MIX KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG MIX KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMALOG MIX KWIKPEN INJECTION SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover HUMALOG MIX KWIKPEN INJECTION SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA 10 MG/0.1 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA 10 MG/0.1 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /28Days |
Humira 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in WI cover Humira 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /28Days |
HUMIRA 20 MG/0.2 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA 20 MG/0.2 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /28Days |
HUMIRA 40 MG/0.4 ML PEN IJ KIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA 40 MG/0.4 ML PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /28Days |
HUMIRA 40 MG/0.4 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA 40 MG/0.4 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /28Days |
HUMIRA 40 MG/0.8 ML PEN ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA 40 MG/0.8 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /28Days |
HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:3 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /30Days |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:6 /28Days |
HUMIRA PEN PSORIASIS-UVEITIS ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA PEN PSORIASIS-UVEITIS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /28Days |
HUMIRA(CF) PEN 80 MG/0.8 ML PEN IJ KIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA(CF) PEN 80 MG/0.8 ML PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /28Days |
HUMIRA(CF) PEN CRHN-UC-HS 80MG PEN IJ KIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA(CF) PEN CRHN-UC-HS 80MG PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:3 /28Days |
HUMIRA(CF) PEN PEDI UC 80 MG PEN IJ KIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA(CF) PEN PEDI UC 80 MG PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:4 /180Days |
HUMIRA(CF) PEN PS-UV-AHS 80-40 PEN IJ KIT ![Compare how all Medicare Part D PDP plans in WI cover HUMIRA(CF) PEN PS-UV-AHS 80-40 PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:3 /28Days |
HUMULIN 70/30 KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN 70/30 KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMULIN N 100 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN N 100 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | P |
HUMULIN R 500 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN R 500 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
HYDRALAZINE 10 MG TABLET [Apresoline] ![Compare how all Medicare Part D PDP plans in WI cover HYDRALAZINE 10 MG TABLET [Apresoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDRALAZINE 100 MG TABLET [Apresoline] ![Compare how all Medicare Part D PDP plans in WI cover HYDRALAZINE 100 MG TABLET [Apresoline].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDRALAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYDRALAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDRALAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYDRALAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HYDREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
Hydrochlorothiazide 12.5 MG Oral Capsule ![Compare how all Medicare Part D PDP plans in WI cover Hydrochlorothiazide 12.5 MG Oral Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCHLOROTHIAZIDE 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYDROCHLOROTHIAZIDE 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCHLOROTHIAZIDE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYDROCHLOROTHIAZIDE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCHLOROTHIAZIDE 50 MG TABLET [Zide] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCHLOROTHIAZIDE 50 MG TABLET [Zide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCODON-ACETAMINOPH 7.5-325 ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODON-ACETAMINOPH 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:360 /30Days |
HYDROCODON-ACETAMINOPHEN 5-325 ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODON-ACETAMINOPHEN 5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:360 /30Days |
HYDROCODONE ER 10 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 10 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 100 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 100 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYDROCODONE ER 120 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 120 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYDROCODONE ER 15 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 15 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 20 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 20 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 20 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 20 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROCODONE ER 30 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 30 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 30 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 30 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE ER 40 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 40 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 40 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 40 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROCODONE ER 50 MG CAPSULE 12H [Zohydro] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 50 MG CAPSULE 12H [Zohydro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:90 /30Days |
HYDROCODONE ER 60 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 60 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROCODONE ER 80 MG TABLET ER 24H [Hysingla ER] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE ER 80 MG TABLET ER 24H [Hysingla ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYDROCODONE-ACETAMIN 10-300 MG TABLET [Xodol] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-ACETAMIN 10-300 MG TABLET [Xodol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:390 /30Days |
HYDROCODONE-ACETAMIN 10-325 MG TABLET [Norco] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-ACETAMIN 10-325 MG TABLET [Norco].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:360 /30Days |
HYDROCODONE-ACETAMIN 5-300 MG TABLET [Xodol] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-ACETAMIN 5-300 MG TABLET [Xodol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:390 /30Days |
HYDROCODONE-ACETAMIN 7.5-300 TABLET [Xodol] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-ACETAMIN 7.5-300 TABLET [Xodol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:390 /30Days |
HYDROCODONE-ACETAMN 7.5-325/15 SOLUTION [Hycet] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-ACETAMN 7.5-325/15 SOLUTION [Hycet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:5550 /30Days |
HYDROCODONE-IBUPROFEN 10-200 TABLET [Xylon 10] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-IBUPROFEN 10-200 TABLET [Xylon 10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:50 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE-IBUPROFEN 5-200 MG ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-IBUPROFEN 5-200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:50 /30Days |
HYDROCODONE-IBUPROFEN 7.5-200 TABLET [Vicoprofen] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCODONE-IBUPROFEN 7.5-200 TABLET [Vicoprofen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:50 /30Days |
HYDROCORT-PRAMOXINE 1%-1% CREAM w/APPL [Zone A] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORT-PRAMOXINE 1%-1% CREAM w/APPL [Zone A].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISON-ACETIC ACID SOLUTION DROPS [VoSoL HC] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISON-ACETIC ACID SOLUTION DROPS [VoSoL HC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 1% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 10 MG TABLET [Hydrocortone] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 10 MG TABLET [Hydrocortone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort] ![Compare how all Medicare Part D PDP plans in WI cover Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 100 MG/60 ML ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 100 MG/60 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 2.5% CREAM (g) [Proctozone-HC] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 2.5% CREAM (g) [Proctozone-HC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 2.5% LOTION ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 2.5% LOTION.](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 |
HYDROCORTISONE 2.5% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 2.5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 20 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 20 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE 5 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE 5 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HYDROCORTISONE BUTYR 0.1% LOTION [Locoid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE BUTYR 0.1% LOTION [Locoid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROCORTISONE BUTYR 0.1% OINTMENT [Locoid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE BUTYR 0.1% OINTMENT [Locoid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE BUTYR 0.1% SOLUTION [Locoid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE BUTYR 0.1% SOLUTION [Locoid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE VAL 0.2% CREAM (g) [Westcort] ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE VAL 0.2% CREAM (g) [Westcort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROCORTISONE VAL 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover HYDROCORTISONE VAL 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROMORPHONE 1 MG/ML SOLUTION LIQUID [Dilaudid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 1 MG/ML SOLUTION LIQUID [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:2400 /30Days |
HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROMORPHONE 2 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 2 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:180 /30Days |
HYDROMORPHONE 4 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 4 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:180 /30Days |
HYDROMORPHONE 50 MG/5 ML AMPUL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 50 MG/5 ML AMPUL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:240 /30Days |
HYDROMORPHONE 8 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE 8 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | Q:180 /30Days |
HYDROMORPHONE HCL ER 12 MG TABLET 24H [Exalgo] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE HCL ER 12 MG TABLET 24H [Exalgo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROMORPHONE HCL ER 16 MG TABLET 24H [Exalgo] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE HCL ER 16 MG TABLET 24H [Exalgo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROMORPHONE HCL ER 32 MG Tablet 24H [Exalgo] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE HCL ER 32 MG Tablet 24H [Exalgo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROMORPHONE HCL ER 8 MG TABLET 24H [Exalgo] ![Compare how all Medicare Part D PDP plans in WI cover HYDROMORPHONE HCL ER 8 MG TABLET 24H [Exalgo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYDROXYCHLOROQUINE 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYCHLOROQUINE 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROXYUREA 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYUREA 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $20.00 | None |
HYDROXYZINE 10 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE 10 MG/5 ML SOLUTION.](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 |
HYDROXYZINE HCL 10 MG TABLET [Rezine] ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE HCL 10 MG TABLET [Rezine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROXYZINE HCL 25 MG TABLET [Atarax] ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE HCL 25 MG TABLET [Atarax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROXYZINE HCL 50 MG TABLET [Atarax] ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE HCL 50 MG TABLET [Atarax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROXYZINE PAM 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE PAM 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYDROXYZINE PAM 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover HYDROXYZINE PAM 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
HYSINGLA ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYSINGLA ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYSINGLA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:150 /30Days |
HYSINGLA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYSINGLA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYSINGLA ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | Q:60 /30Days |
HYSINGLA ER 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYSINGLA ER 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
HYZAAR 100-12.5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYZAAR 100-12.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HYZAAR 100-25 TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYZAAR 100-25 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |
HYZAAR 50-12.5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover HYZAAR 50-12.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$90.00 | $225.00 | None |