2022 Medicare Part D Plan Formulary Information |
iCare Medicare Plan (HMO D-SNP) (H2237-001-0)
Benefit Details
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The iCare Medicare Plan (HMO D-SNP) (H2237-001-0) Formulary Drugs Starting with the Letter E in Calumet County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter E
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
EDURANT 27.5mg/1 ![Compare how all Medicare Part D PDP plans in WI cover EDURANT 27.5mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIR-EMTRI-TENOF 600-200-300 TABLET [Atripla] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIR-EMTRI-TENOF 600-200-300 TABLET [Atripla].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIR-LAMIV-TENOF 400-300-300 TABLET [SYMFI LO] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIR-LAMIV-TENOF 400-300-300 TABLET [SYMFI LO].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIR-LAMIV-TENOF 600-300-300 TABLET [SYMFI] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIR-LAMIV-TENOF 600-300-300 TABLET [SYMFI].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EFAVIRENZ 200 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIRENZ 200 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EFAVIRENZ 50 MG CAPSULE [Sustiva] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIRENZ 50 MG CAPSULE [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EFAVIRENZ 600 MG TABLET [Sustiva] ![Compare how all Medicare Part D PDP plans in WI cover EFAVIRENZ 600 MG TABLET [Sustiva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ELIGARD 22.5 MG SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 22.5 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ELIGARD 30 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 30 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ELIGARD 45 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 45 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ELIGARD 7.5 MG SYRINGE KIT ![Compare how all Medicare Part D PDP plans in WI cover ELIGARD 7.5 MG SYRINGE KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ELIQUIS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ELIQUIS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:60 /30Days |
ELIQUIS 5 MG STARTER PACK ![Compare how all Medicare Part D PDP plans in WI cover ELIQUIS 5 MG STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
ELIQUIS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ELIQUIS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:74 /30Days |
EMCYT 140MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EMCYT 140MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMGALITY 120 MG/ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover EMGALITY 120 MG/ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | P Q:2 /30Days |
EMGALITY 120 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover EMGALITY 120 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | P Q:2 /30Days |
EMGALITY 300 MG (100 MG X3SYR) SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover EMGALITY 300 MG (100 MG X3SYR) SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | P Q:3 /30Days |
EMOQUETTE 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover EMOQUETTE 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy] ![Compare how all Medicare Part D PDP plans in WI cover Empagliflozin 5 MG / Metformin hydrochloride 500 MG Oral Tablet [Synjardy].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:60 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 12MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 6MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | S Q:30 /30Days |
EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H ![Compare how all Medicare Part D PDP plans in WI cover EMSAM TRANSDERMAL SYSTEM PATCHES 9MG/24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | S Q:30 /30Days |
EMTRICITABINE 200 MG CAPSULE [Emtriva] ![Compare how all Medicare Part D PDP plans in WI cover EMTRICITABINE 200 MG CAPSULE [Emtriva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EMTRICITABINE-TENOFV 100-150MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in WI cover EMTRICITABINE-TENOFV 100-150MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 133-200MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in WI cover EMTRICITABINE-TENOFV 133-200MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 167-250MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in WI cover EMTRICITABINE-TENOFV 167-250MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRICITABINE-TENOFV 200-300MG TABLET [Truvada] ![Compare how all Medicare Part D PDP plans in WI cover EMTRICITABINE-TENOFV 200-300MG TABLET [Truvada].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EMTRIVA 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EMTRIVA 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ENALAPRIL MALEATE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ENALAPRIL MALEATE 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ENALAPRIL MALEATE 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENALAPRIL MALEATE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL MALEATE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ENALAPRIL-HCTZ 10-25 MG TABLET [Vaseretic] ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL-HCTZ 10-25 MG TABLET [Vaseretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ENALAPRIL-HCTZ 5-12.5 MG TABLET [Vaseretic] ![Compare how all Medicare Part D PDP plans in WI cover ENALAPRIL-HCTZ 5-12.5 MG TABLET [Vaseretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ENBREL 25 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENBREL 25 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENBREL 25MG KIT ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 25MG KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENBREL 50 MG/ML MINI CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50 MG/ML MINI CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENBREL 50 MG/ML SURECLICK PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50 MG/ML SURECLICK PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENBREL 50 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENBREL 50 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
ENDOCET 10MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 10MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:180 /30Days |
ENDOCET 5/325 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 5/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENDOCET 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENDOCET 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:240 /30Days |
ENGERIX B INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX B INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | P |
ENGERIX-B 20 MCG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ENGERIX-B 20 MCG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | P |
ENOXAPARIN 100 MG/ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 100 MG/ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
ENOXAPARIN 120 MG/0.8 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 120 MG/0.8 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:48 /30Days |
ENOXAPARIN 150 MG/ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 150 MG/ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
ENOXAPARIN 30 MG/0.3 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 30 MG/0.3 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:18 /30Days |
ENOXAPARIN 40 MG/0.4 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 40 MG/0.4 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:24 /30Days |
ENOXAPARIN 60 MG/0.6 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 60 MG/0.6 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:36 /30Days |
ENOXAPARIN 80 MG/0.8 ML SYRINGE [Lovenox] ![Compare how all Medicare Part D PDP plans in WI cover ENOXAPARIN 80 MG/0.8 ML SYRINGE [Lovenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:48 /30Days |
ENSKYCE 28 TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover ENSKYCE 28 TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ENTACAPONE 200 MG TABLET [Comtan] ![Compare how all Medicare Part D PDP plans in WI cover ENTACAPONE 200 MG TABLET [Comtan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ENTECAVIR 0.5 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in WI cover ENTECAVIR 0.5 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ENTECAVIR 1 MG TABLET [Baraclude] ![Compare how all Medicare Part D PDP plans in WI cover ENTECAVIR 1 MG TABLET [Baraclude].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ENTRESTO 24 MG-26 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 24 MG-26 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:180 /30Days |
ENTRESTO 49 MG-51 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 49 MG-51 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:60 /30Days |
ENTRESTO 97 MG-103 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ENTRESTO 97 MG-103 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:60 /30Days |
ENULOSE 10 GM/15 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover ENULOSE 10 GM/15 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
EPCLUSA 150-37.5 MG PELLET PACK ![Compare how all Medicare Part D PDP plans in WI cover EPCLUSA 150-37.5 MG PELLET PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EPCLUSA 200 MG-50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPCLUSA 200 MG-50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EPCLUSA 200-50 MG PELLET PACK ![Compare how all Medicare Part D PDP plans in WI cover EPCLUSA 200-50 MG PELLET PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
EPCLUSA 400 MG-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPCLUSA 400 MG-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EPIDIOLEX 100 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EPIDIOLEX 100 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EPINASTINE HCL 0.05% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover EPINASTINE HCL 0.05% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EPINEPHRINE 0.15 MG AUTO-INJECT [Twinject] ![Compare how all Medicare Part D PDP plans in WI cover EPINEPHRINE 0.15 MG AUTO-INJECT [Twinject].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:4 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT ![Compare how all Medicare Part D PDP plans in WI cover EPINEPHRINE 0.3 MG AUTO-INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:4 /30Days |
EPINEPHRINE 0.3 MG AUTO-INJECT [Twinject] ![Compare how all Medicare Part D PDP plans in WI cover EPINEPHRINE 0.3 MG AUTO-INJECT [Twinject].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:4 /30Days |
EPITOL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EPITOL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
EPIVIR HBV 25MG/5ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover EPIVIR HBV 25MG/5ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EPLERENONE 25 MG TABLET [Inspra] ![Compare how all Medicare Part D PDP plans in WI cover EPLERENONE 25 MG TABLET [Inspra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EPLERENONE 50 MG TABLET [Inspra] ![Compare how all Medicare Part D PDP plans in WI cover EPLERENONE 50 MG TABLET [Inspra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EPRONTIA 25 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover EPRONTIA 25 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:480 /30Days |
ERIVEDGE 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ERIVEDGE 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ERLEADA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ERLEADA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
ERLOTINIB HCL 100 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in WI cover ERLOTINIB HCL 100 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
ERLOTINIB HCL 150 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in WI cover ERLOTINIB HCL 150 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:90 /30Days |
ERLOTINIB HCL 25 MG TABLET [Tarceva] ![Compare how all Medicare Part D PDP plans in WI cover ERLOTINIB HCL 25 MG TABLET [Tarceva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:60 /30Days |
ERRIN 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in WI cover ERRIN 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ERTAPENEM 1 GRAM VIAL [Invanz] ![Compare how all Medicare Part D PDP plans in WI cover ERTAPENEM 1 GRAM VIAL [Invanz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ERY 2% PADS 2% 60 PADS JAR ![Compare how all Medicare Part D PDP plans in WI cover ERY 2% PADS 2% 60 PADS JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ERYTHROMYCIN 0.5% EYE OINTMENT [Romycin] ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 0.5% EYE OINTMENT [Romycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | Q:4 /4Days |
ERYTHROMYCIN 2% SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 2% SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:180 /30Days |
ERYTHROMYCIN 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ERYTHROMYCIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ERYTHROMYCIN 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESBRIET 267 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ESBRIET 267 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:270 /30Days |
ESCITALOPRAM 10 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 10 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ESCITALOPRAM 20 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 20 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ESCITALOPRAM 5 MG TABLET [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM 5 MG TABLET [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | None |
ESCITALOPRAM OXALATE 5 MG/5 ML SOLUTION [Lexapro] ![Compare how all Medicare Part D PDP plans in WI cover ESCITALOPRAM OXALATE 5 MG/5 ML SOLUTION [Lexapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ESOMEPRAZOLE MAG DR 20 MG CAPSULE DR [Nexium 24HR Clear Minis] ![Compare how all Medicare Part D PDP plans in WI cover ESOMEPRAZOLE MAG DR 20 MG CAPSULE DR [Nexium 24HR Clear Minis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | Q:30 /30Days |
ESOMEPRAZOLE MAG DR 40 MG CAPSULE DR [Nexium] ![Compare how all Medicare Part D PDP plans in WI cover ESOMEPRAZOLE MAG DR 40 MG CAPSULE DR [Nexium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | Q:60 /30Days |
ESTARYLLA 0.25-0.035 MG TABLET [VyLibra] ![Compare how all Medicare Part D PDP plans in WI cover ESTARYLLA 0.25-0.035 MG TABLET [VyLibra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
Estradiol / Norethindrone Acetate 0.5; 0.1mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, FILM C ![Compare how all Medicare Part D PDP plans in WI cover Estradiol / Norethindrone Acetate 0.5; 0.1mg/1; mg/1 1 BLISTER PACK per CARTON / 28 TABLET, FILM C.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
ESTRADIOL 0.01% CREAM ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.01% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
Estradiol 0.025 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.025 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 0.0375MG PATCH(1/WKClimara] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.0375MG PATCH(1/WKClimara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
ESTRADIOL 0.0375MG PATCH(2/WK) TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.0375MG PATCH(2/WK) TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:8 /28Days |
Estradiol 0.05 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.05 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:8 /28Days |
ESTRADIOL 0.05 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.05 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
ESTRADIOL 0.06 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.06 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
Estradiol 0.075 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.075 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:8 /28Days |
ESTRADIOL 0.075 MG PATCH(1/WKClimara] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.075 MG PATCH(1/WKClimara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
Estradiol 0.1 mg patch ![Compare how all Medicare Part D PDP plans in WI cover Estradiol 0.1 mg patch.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:8 /28Days |
ESTRADIOL 0.1 MG PATCH (1/WK) [Climara] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.1 MG PATCH (1/WK) [Climara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
ESTRADIOL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | P |
ESTRADIOL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ESTRADIOL 10 MCG VAGINAL INSRT ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 10 MCG VAGINAL INSRT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:18 /28Days |
ESTRADIOL 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$6.00 | $18.00 | P |
ESTRADIOL TDS 0.025 MG/DAY ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL TDS 0.025 MG/DAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:4 /28Days |
ESTRADIOL VALERATE 100 MG/5 ML VIAL [Gynogen LA] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL VALERATE 100 MG/5 ML VIAL [Gynogen LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ESTRADIOL VALERATE 200 MG/5 ML VIAL [Delestrogen] ![Compare how all Medicare Part D PDP plans in WI cover ESTRADIOL VALERATE 200 MG/5 ML VIAL [Delestrogen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETHAMBUTOL HCL 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ETHAMBUTOL HCL 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
Ethambutol Hydrochloride 100mg/1 ![Compare how all Medicare Part D PDP plans in WI cover Ethambutol Hydrochloride 100mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / LEVONORGESTREL 0.05 MG ORAL TABLET) / 10 (ETHINYL ESTRADIOL 0.03 MG 6.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TABLET 21 ![Compare how all Medicare Part D PDP plans in WI cover ETHINYL ESTRADIOL 0.03 MG / NORGESTREL 0.3 MG ORAL TABLET/ 7 (INERT INGREDIENTS 1 MG ORAL TABLET 21.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ETHOSUXIMIDE 250 MG CAPSULE [Zarontin] ![Compare how all Medicare Part D PDP plans in WI cover ETHOSUXIMIDE 250 MG CAPSULE [Zarontin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETHOSUXIMIDE 250 MG/5 ML SOLUTION [Zarontin] ![Compare how all Medicare Part D PDP plans in WI cover ETHOSUXIMIDE 250 MG/5 ML SOLUTION [Zarontin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA] ![Compare how all Medicare Part D PDP plans in WI cover ETHYNODIOL-ETH ESTRA 1MG-35MCG [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ETHYNODIOL-ETH ESTRA 1MG-50MCG [ZOVIA] ![Compare how all Medicare Part D PDP plans in WI cover ETHYNODIOL-ETH ESTRA 1MG-50MCG [ZOVIA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | None |
ETODOLAC 200 MG CAPSULE [Lodine] ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 200 MG CAPSULE [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETODOLAC 300 MG CAPSULE [Lodine] ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 300 MG CAPSULE [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETODOLAC 400 MG TABLET [Lodine] ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 400 MG TABLET [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETODOLAC 500 MG TABLET [Lodine] ![Compare how all Medicare Part D PDP plans in WI cover ETODOLAC 500 MG TABLET [Lodine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
ETRAVIRINE 100 MG TABLET [INTELENCE] ![Compare how all Medicare Part D PDP plans in WI cover ETRAVIRINE 100 MG TABLET [INTELENCE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
ETRAVIRINE 200 MG TABLET [INTELENCE] ![Compare how all Medicare Part D PDP plans in WI cover ETRAVIRINE 200 MG TABLET [INTELENCE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EVEROLIMUS 0.25 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 0.25 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
EVEROLIMUS 0.5 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 0.5 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 0.75 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 0.75 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EVEROLIMUS 1 MG TABLET [Zortress] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 1 MG TABLET [Zortress].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
EVEROLIMUS 10 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 10 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:56 /28Days |
EVEROLIMUS 2 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 2 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:112 /28Days |
EVEROLIMUS 2.5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 2.5 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EVEROLIMUS 3 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 3 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:112 /28Days |
EVEROLIMUS 5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 5 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EVEROLIMUS 5 MG TABLET FOR SUSP [Afinitor DISPERZ] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 5 MG TABLET FOR SUSP [Afinitor DISPERZ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:112 /28Days |
EVEROLIMUS 7.5 MG TABLET [Afinitor] ![Compare how all Medicare Part D PDP plans in WI cover EVEROLIMUS 7.5 MG TABLET [Afinitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:28 /28Days |
EVOTAZ 300 MG-150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover EVOTAZ 300 MG-150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
EXEMESTANE 25 MG TABLET [Aromasin] ![Compare how all Medicare Part D PDP plans in WI cover EXEMESTANE 25 MG TABLET [Aromasin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
EXKIVITY 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover EXKIVITY 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
EYSUVIS 0.25% EYE DROPS EYE DROPPER ![Compare how all Medicare Part D PDP plans in WI cover EYSUVIS 0.25% EYE DROPS EYE DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$20.00 | $60.00 | Q:8 /14Days |
EZETIMIBE 10 MG TABLET [Zetia] ![Compare how all Medicare Part D PDP plans in WI cover EZETIMIBE 10 MG TABLET [Zetia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$10.00 | $30.00 | Q:30 /30Days |