2022 Medicare Part D Plan Formulary Information |
Network PlatinumChoice (PPO) (H5215-011-0)
Benefit Details
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The Network PlatinumChoice (PPO) (H5215-011-0) Formulary Drugs Starting with the Letter S in Calumet County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter S
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Safyral 3 BLISTER PACK in 1 PACKAGE / 1 KIT per BLISTER PACK ![Compare how all Medicare Part D PDP plans in WI cover Safyral 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 Drug |
$95.00 | $237.00 | None |
SAIZEN 5 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SAIZEN 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SAIZEN 8.8 MG SAIZENPREP CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SAIZEN 8.8 MG SAIZENPREP CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SAIZEN 8.8 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SAIZEN 8.8 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SAJAZIR 30 MG/3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SAJAZIR 30 MG/3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:27 /30Days |
SALAGEN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SALAGEN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SALAGEN 7.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SALAGEN 7.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN ![Compare how all Medicare Part D PDP plans in WI cover SANCUSO TRANSDERMAL SYSTEM 3.1MG/24HRS 1 PATCH CRTN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:4 /28Days |
SANDIMMUNE 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SANDIMMUNE 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SANDIMMUNE 100MG/ML TUBEX ![Compare how all Medicare Part D PDP plans in WI cover SANDIMMUNE 100MG/ML TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SANDIMMUNE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SANDIMMUNE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SANDOSTATIN 0.05MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in WI cover SANDOSTATIN 0.05MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
Sandostatin 100ug/mL 10 AMPULE in 1 PACKAGE / 1 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in WI cover Sandostatin 100ug/mL 10 AMPULE in 1 PACKAGE / 1 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Sandostatin 500ug/mL 10 AMPULE in 1 PACKAGE / 1 mL in 1 AMPULE ![Compare how all Medicare Part D PDP plans in WI cover Sandostatin 500ug/mL 10 AMPULE in 1 PACKAGE / 1 mL in 1 AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SANTYL OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover SANTYL OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SAPHRIS 10 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in WI cover SAPHRIS 10 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S |
SAPHRIS 2.5 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in WI cover SAPHRIS 2.5 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SAPHRIS 5 MG TABLET SL BLACK CHERRY ![Compare how all Medicare Part D PDP plans in WI cover SAPHRIS 5 MG TABLET SL BLACK CHERRY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SAPROPTERIN 100 MG POWDER PACK [KUVAN] ![Compare how all Medicare Part D PDP plans in WI cover SAPROPTERIN 100 MG POWDER PACK [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SAPROPTERIN 100 MG TABLET SOL [KUVAN] ![Compare how all Medicare Part D PDP plans in WI cover SAPROPTERIN 100 MG TABLET SOL [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SAPROPTERIN 500 MG POWDER PACK [KUVAN] ![Compare how all Medicare Part D PDP plans in WI cover SAPROPTERIN 500 MG POWDER PACK [KUVAN].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SAVELLA TABLETS 100MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in WI cover SAVELLA TABLETS 100MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SAVELLA TABLETS 12.5MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in WI cover SAVELLA TABLETS 12.5MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SAVELLA TABLETS 25MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in WI cover SAVELLA TABLETS 25MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM ![Compare how all Medicare Part D PDP plans in WI cover SAVELLA TABLETS TITRATION PACK KIT 12.5;25;50MG;MG;MG 55 COUNT PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SAVELLA TALBETS 50MG 60 COUNT BOT ![Compare how all Medicare Part D PDP plans in WI cover SAVELLA TALBETS 50MG 60 COUNT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SCEMBLIX 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SCEMBLIX 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:60 /30Days |
SCEMBLIX 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SCEMBLIX 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:300 /30Days |
SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop] ![Compare how all Medicare Part D PDP plans in WI cover SCOPOLAMINE 1 MG/3 DAY PATCH TD 3 [Transderm Scop].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS ![Compare how all Medicare Part D PDP plans in WI cover SEASONIQUE 150-30(84) TABLET DOSE PACK 3 MONTHS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SECUADO 3.8 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover SECUADO 3.8 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:30 /30Days |
SECUADO 5.7 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover SECUADO 5.7 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SECUADO 7.6 MG/24 HR PATCH ![Compare how all Medicare Part D PDP plans in WI cover SECUADO 7.6 MG/24 HR PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | S Q:30 /30Days |
SEGLUROMET 2.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEGLUROMET 2.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
SEGLUROMET 2.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEGLUROMET 2.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:120 /30Days |
SEGLUROMET 7.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEGLUROMET 7.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
SEGLUROMET 7.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEGLUROMET 7.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
SELEGILINE HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SELEGILINE HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SELEGILINE HCL 5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SELEGILINE HCL 5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SELENIUM SULFIDE 2.5mg/100mL 118 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SELZENTRY 150mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SELZENTRY 20 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SELZENTRY 20 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SELZENTRY 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SELZENTRY 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SELZENTRY 300mg/1 60 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SELZENTRY 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SELZENTRY 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SEMGLEE (YFGN) 100 UNIT/ML INSULN PEN ![Compare how all Medicare Part D PDP plans in WI cover SEMGLEE (YFGN) 100 UNIT/ML INSULN PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SEMGLEE (YFGN) 100 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover SEMGLEE (YFGN) 100 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SENSIPAR 30MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SENSIPAR 30MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:60 /30Days |
SENSIPAR 60MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SENSIPAR 60MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:60 /30Days |
SENSIPAR 90MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SENSIPAR 90MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:120 /30Days |
SEREVENT DIS AER 50MCG ![Compare how all Medicare Part D PDP plans in WI cover SEREVENT DIS AER 50MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
SEROQUEL 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
SEROQUEL 200MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 200MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
SEROQUEL 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SEROQUEL 300MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 300MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
SEROQUEL 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
SEROQUEL 50MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL 50MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
SEROQUEL XR 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL XR 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S Q:30 /30Days |
SEROQUEL XR 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL XR 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S Q:30 /30Days |
SEROQUEL XR 300MG TABLET 60X300MG BOT ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL XR 300MG TABLET 60X300MG BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S Q:60 /30Days |
SEROQUEL XR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL XR 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S Q:60 /30Days |
SEROQUEL XR 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SEROQUEL XR 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S Q:60 /30Days |
Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Serostim 4mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Serostim 5mg/mL 1 INJECTION, POWDER, FOR SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SERTRALINE 20 MG/ML ORAL CONC [Zoloft] ![Compare how all Medicare Part D PDP plans in WI cover SERTRALINE 20 MG/ML ORAL CONC [Zoloft].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SERTRALINE HCL 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SERTRALINE HCL 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SERTRALINE HCL 25 MG TABLET [Zoloft] ![Compare how all Medicare Part D PDP plans in WI cover SERTRALINE HCL 25 MG TABLET [Zoloft].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SERTRALINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SERTRALINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SETLAKIN 0.15 MG-0.03 MG TAB ![Compare how all Medicare Part D PDP plans in WI cover SETLAKIN 0.15 MG-0.03 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SEVELAMER 0.8 GM POWDER PACKET [RENVELA] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER 0.8 GM POWDER PACKET [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SEVELAMER 2.4 GM POWDER PACKET POWDER PACK [Renvela] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER 2.4 GM POWDER PACKET POWDER PACK [Renvela].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER CARBONATE 26.7 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER CARBONATE 40 MG/ML ORAL SUSPENSION [RENVELA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SEVELAMER CARBONATE 800 MG TABLET [Renvela] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER CARBONATE 800 MG TABLET [Renvela].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SEVELAMER HCL 400 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER HCL 400 MG TABLET [RenaGel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SEVELAMER HCL 800 MG TABLET [RenaGel] ![Compare how all Medicare Part D PDP plans in WI cover SEVELAMER HCL 800 MG TABLET [RenaGel].](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 |
SHAROBEL 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SHAROBEL 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SHINGRIX VIAL KIT ![Compare how all Medicare Part D PDP plans in WI cover SHINGRIX VIAL KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SIGNIFOR 0.3 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover SIGNIFOR 0.3 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SIGNIFOR 0.6 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover SIGNIFOR 0.6 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SIGNIFOR 0.9 MG/ML AMPULE ![Compare how all Medicare Part D PDP plans in WI cover SIGNIFOR 0.9 MG/ML AMPULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SIKLOS 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIKLOS 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SIKLOS 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIKLOS 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio] ![Compare how all Medicare Part D PDP plans in WI cover SILDENAFIL 10 MG/ML ORAL SUSPENSION [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SILDENAFIL 20 MG TABLET [Revatio] ![Compare how all Medicare Part D PDP plans in WI cover SILDENAFIL 20 MG TABLET [Revatio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
SILENOR 3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SILENOR 3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SILENOR 6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SILENOR 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SILIQ 210 MG/1.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SILIQ 210 MG/1.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SILODOSIN 4 MG CAPSULE [Rapaflo] ![Compare how all Medicare Part D PDP plans in WI cover SILODOSIN 4 MG CAPSULE [Rapaflo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SILODOSIN 8 MG CAPSULE [Rapaflo] ![Compare how all Medicare Part D PDP plans in WI cover SILODOSIN 8 MG CAPSULE [Rapaflo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SILVER SULFADIAZINE 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover SILVER SULFADIAZINE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Silver sulfadiazine 10 MG/ML Topical Cream [Silvadene] ![Compare how all Medicare Part D PDP plans in WI cover Silver sulfadiazine 10 MG/ML Topical Cream [Silvadene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SIMBRINZA 1%-0.2% EYE DROPS EYE DROPPER ![Compare how all Medicare Part D PDP plans in WI cover SIMBRINZA 1%-0.2% EYE DROPS EYE DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SIMPONI 100 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover SIMPONI 100 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SIMPONI 100 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SIMPONI 100 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SIMPONI 50 MG/0.5 ML PEN INJEC ![Compare how all Medicare Part D PDP plans in WI cover SIMPONI 50 MG/0.5 ML PEN INJEC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR ![Compare how all Medicare Part D PDP plans in WI cover SIMPONI GOLIMUMAB INJECTION 50MG/0.5ML 1 50 MG SINGLE DOSE SYR SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SIMVASTATIN 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIMVASTATIN 10 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 |
SIMVASTATIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIMVASTATIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SIMVASTATIN 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIMVASTATIN 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SIMVASTATIN 5 MG TABLET [Zocor] ![Compare how all Medicare Part D PDP plans in WI cover SIMVASTATIN 5 MG TABLET [Zocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SIMVASTATIN 80 MG TABLET [Zocor] ![Compare how all Medicare Part D PDP plans in WI cover SIMVASTATIN 80 MG TABLET [Zocor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SINEMET 10-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SINEMET 10-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SINEMET 25-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SINEMET 25-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SINGULAIR 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SINGULAIR 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SINGULAIR 4 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover SINGULAIR 4 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SINGULAIR 4 MG GRANULES GRAN PACK ![Compare how all Medicare Part D PDP plans in WI cover SINGULAIR 4 MG GRANULES GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SINGULAIR 5 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover SINGULAIR 5 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Sirolimus 0.5 MG Tablet [Rapamune] ![Compare how all Medicare Part D PDP plans in WI cover Sirolimus 0.5 MG Tablet [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SIROLIMUS 1 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in WI cover SIROLIMUS 1 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
SIROLIMUS 1 MG/ML SOLUTION [Rapamune] ![Compare how all Medicare Part D PDP plans in WI cover SIROLIMUS 1 MG/ML SOLUTION [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SIROLIMUS 2 MG TABLET [Rapamune] ![Compare how all Medicare Part D PDP plans in WI cover SIROLIMUS 2 MG TABLET [Rapamune].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
SIRTURO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIRTURO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SIRTURO 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIRTURO 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SIVEXTRO 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SIVEXTRO 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SIVEXTRO 200 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SIVEXTRO 200 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SKYRIZI 150 MG DOSE KIT-2 SYRINGEKIT ![Compare how all Medicare Part D PDP plans in WI cover SKYRIZI 150 MG DOSE KIT-2 SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SKYRIZI 150 MG/ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover SKYRIZI 150 MG/ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SKYRIZI 150 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SKYRIZI 150 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:1 /28Days |
SKYTROFA 11 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 11 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SKYTROFA 13.3 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 13.3 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 3 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 3 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 3.6 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 3.6 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 4.3 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 4.3 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 5.2 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 5.2 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 6.3 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 6.3 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 7.6 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 7.6 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SKYTROFA 9.1 MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover SKYTROFA 9.1 MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SLYND 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SLYND 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SODIUM CHLORIDE 0.45% SOLUTION IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SODIUM CHLORIDE 0.45% SOLUTION IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SODIUM CHLORIDE 0.9% IRRIG. ![Compare how all Medicare Part D PDP plans in WI cover SODIUM CHLORIDE 0.9% IRRIG..](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SODIUM CHLORIDE 0.9% SOLUTION PGY VL PRT ![Compare how all Medicare Part D PDP plans in WI cover SODIUM CHLORIDE 0.9% SOLUTION PGY VL PRT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SODIUM CHLORIDE 3% IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SODIUM CHLORIDE 3% IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SODIUM CHLORIDE INJECTION USP 5% ![Compare how all Medicare Part D PDP plans in WI cover SODIUM CHLORIDE INJECTION USP 5%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SODIUM PHENYLBUTYRATE 500MG TB [Buphenyl] ![Compare how all Medicare Part D PDP plans in WI cover SODIUM PHENYLBUTYRATE 500MG TB [Buphenyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SODIUM PHENYLBUTYRATE POWDER [Buphenyl] ![Compare how all Medicare Part D PDP plans in WI cover SODIUM PHENYLBUTYRATE POWDER [Buphenyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SODIUM POLYSTYRENE SULF POWDER ![Compare how all Medicare Part D PDP plans in WI cover SODIUM POLYSTYRENE SULF POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa] ![Compare how all Medicare Part D PDP plans in WI cover SOFOSBUVIR-VELPATASVIR 400-100 TABLET [Epclusa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SOLIFENACIN 10 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in WI cover SOLIFENACIN 10 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOLIFENACIN 5 MG TABLET [VESIcare] ![Compare how all Medicare Part D PDP plans in WI cover SOLIFENACIN 5 MG TABLET [VESIcare].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOLIQUA 100 UNIT-33 MCG/ML PEN ![Compare how all Medicare Part D PDP plans in WI cover SOLIQUA 100 UNIT-33 MCG/ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:15 /25Days |
SOLOSEC 2 GM GRANULE PACKET GRANDR PKT ![Compare how all Medicare Part D PDP plans in WI cover SOLOSEC 2 GM GRANULE PACKET GRANDR PKT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOLTAMOX 20 MG/10 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SOLTAMOX 20 MG/10 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOMA 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SOMA 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SOMA 350MG TABLETS ![Compare how all Medicare Part D PDP plans in WI cover SOMA 350MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
SOMAVERT 10 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SOMAVERT 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOMAVERT 15 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SOMAVERT 15 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOMAVERT 20 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SOMAVERT 20 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOMAVERT 25 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SOMAVERT 25 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOMAVERT 30 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover SOMAVERT 30 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SOOLANTRA 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover SOOLANTRA 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SORAFENIB 200 MG TABLET [Nexavar] ![Compare how all Medicare Part D PDP plans in WI cover SORAFENIB 200 MG TABLET [Nexavar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SORILUX 0.005% FOAM ![Compare how all Medicare Part D PDP plans in WI cover SORILUX 0.005% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover SORINE SOLTALOL HCL TABLETS 240MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover SORINE SOTALOL HCL TABLETS 120MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover SORINE SOTALOL HCL TABLETS 160MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD ![Compare how all Medicare Part D PDP plans in WI cover SORINE SOTALOL HCL TABLETS 80MG 100 BOXUD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL 120 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL 120 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL 240 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL 240 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL AF 120 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL AF 120 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL AF 160 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL AF 160 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SOTALOL AF 80 MG TABLET [Sorine] ![Compare how all Medicare Part D PDP plans in WI cover SOTALOL AF 80 MG TABLET [Sorine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SOTYLIZE 5 MG/ML ORAL SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SOTYLIZE 5 MG/ML ORAL SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SOVALDI 150 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in WI cover SOVALDI 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 |
SOVALDI 200 MG PELLET PACKET ![Compare how all Medicare Part D PDP plans in WI cover SOVALDI 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 |
SOVALDI 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SOVALDI 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SPINOSAD 0.9% TOPICAL SUSPENSION SUSPENSION [Natroba] ![Compare how all Medicare Part D PDP plans in WI cover SPINOSAD 0.9% TOPICAL SUSPENSION SUSPENSION [Natroba].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SPIRIVA 18 MCG CP-HANDIHALER ![Compare how all Medicare Part D PDP plans in WI cover SPIRIVA 18 MCG CP-HANDIHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
SPIRIVA RESPIMAT 1.25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover SPIRIVA RESPIMAT 1.25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /30Days |
SPIRIVA RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover SPIRIVA RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /30Days |
SPIRONOLACTONE 100 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in WI cover SPIRONOLACTONE 100 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SPIRONOLACTONE 25 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in WI cover SPIRONOLACTONE 25 MG TABLET [Aldactone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
SPIRONOLACTONE 50 MG TABLET [Aldactone] ![Compare how all Medicare Part D PDP plans in WI cover SPIRONOLACTONE 50 MG TABLET [Aldactone].](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 |
SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide] ![Compare how all Medicare Part D PDP plans in WI cover SPIRONOLACTONE-HCTZ 25-25 TABLET [Aldactazide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SPORANOX 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SPORANOX 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SPORANOX 10MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SPORANOX 10MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SPRINTEC 0.25-0.035 TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRINTEC 0.25-0.035 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SPRITAM 1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRITAM 1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SPRITAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRITAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SPRITAM 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRITAM 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SPRITAM 750 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRITAM 750 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 100mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 140mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
SPRYCEL 20MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SPRYCEL 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:90 /30Days |
SPRYCEL 70MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 70MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SPRYCEL 80mg/1 1 BOTTLE per CARTON / 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:60 /30Days |
SPS 15 GM/60 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover SPS 15 GM/60 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SRONYX 0.10-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SRONYX 0.10-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SSD 1% CREAM ![Compare how all Medicare Part D PDP plans in WI cover SSD 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
STALEVO 100 TABLET ![Compare how all Medicare Part D PDP plans in WI cover STALEVO 100 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STALEVO 125 TABLET ![Compare how all Medicare Part D PDP plans in WI cover STALEVO 125 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STALEVO 150 TABLET ![Compare how all Medicare Part D PDP plans in WI cover STALEVO 150 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STALEVO 200 TABLET ![Compare how all Medicare Part D PDP plans in WI cover STALEVO 200 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STALEVO 75 TABLET ![Compare how all Medicare Part D PDP plans in WI cover STALEVO 75 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STEGLATRO 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STEGLATRO 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
STEGLATRO 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STEGLATRO 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
STEGLUJAN 15-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STEGLUJAN 15-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
STEGLUJAN 5-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STEGLUJAN 5-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
STELARA 45 MG/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover STELARA 45 MG/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
STELARA 45 MG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover STELARA 45 MG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
STELARA 90 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover STELARA 90 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON ![Compare how all Medicare Part D PDP plans in WI cover Sterile Water 6mg/mL 1 INJECTION, SOLUTION per CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
STIOLTO RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover STIOLTO RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /30Days |
STIVARGA 40 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STIVARGA 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:112 /28Days |
STRATTERA 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
STRATTERA 10MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 10MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRATTERA 18MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 18MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRATTERA 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRATTERA 40MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 40MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRATTERA 60MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 60MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRATTERA 80MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover STRATTERA 80MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STREPTOMYCIN FOR INJECTION 1GM/VIL ![Compare how all Medicare Part D PDP plans in WI cover STREPTOMYCIN FOR INJECTION 1GM/VIL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
STRIBILD TABLET ![Compare how all Medicare Part D PDP plans in WI cover STRIBILD TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
STRIVERDI RESPIMAT INHAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover STRIVERDI RESPIMAT INHAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:4 /30Days |
STROMECTOL 3MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover STROMECTOL 3MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUBOXONE 12 MG-3 MG SL FILM ![Compare how all Medicare Part D PDP plans in WI cover SUBOXONE 12 MG-3 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Suboxone 2; 0.5mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in WI cover Suboxone 2; 0.5mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:360 /30Days |
SUBOXONE 4 MG-1 MG SL FILM ![Compare how all Medicare Part D PDP plans in WI cover SUBOXONE 4 MG-1 MG SL FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
Suboxone 8; 2mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH ![Compare how all Medicare Part D PDP plans in WI cover Suboxone 8; 2mg/1; mg/1 30 POUCH per CARTON / 1 FILM, SOLUBLE in 1 POUCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
SUCRAID 8500[iU]/mL ![Compare how all Medicare Part D PDP plans in WI cover SUCRAID 8500[iU]/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SUCRALFATE 1 GM/10 ML ORAL SUSPENSION [Carafate] ![Compare how all Medicare Part D PDP plans in WI cover SUCRALFATE 1 GM/10 ML ORAL SUSPENSION [Carafate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SUCRALFATE 1GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover SUCRALFATE 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULAR ER 17 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover SULAR ER 17 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SULAR ER 34 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover SULAR ER 34 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SULAR ER 8.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SULAR ER 8.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SULF-PRED 10-0.23% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover SULF-PRED 10-0.23% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFACETAMIDE 10% EYE DROPS [Sulf-10] ![Compare how all Medicare Part D PDP plans in WI cover SULFACETAMIDE 10% EYE DROPS [Sulf-10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SULFACETAMIDE 10% EYE OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover SULFACETAMIDE 10% EYE OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFACETAMIDE SOD 10% TOP SUSP ![Compare how all Medicare Part D PDP plans in WI cover SULFACETAMIDE SOD 10% TOP SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFADIAZINE 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SULFADIAZINE 500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS] ![Compare how all Medicare Part D PDP plans in WI cover SULFAMETHOXAZOLE-TMP DS TABLET [Septra DS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFAMETHOXAZOLE-TMP ORAL SUSPENSION [Sultrex Pediatric] ![Compare how all Medicare Part D PDP plans in WI cover SULFAMETHOXAZOLE-TMP ORAL SUSPENSION [Sultrex Pediatric].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFAMETHOXAZOLE-TMP SS TABLET [Septra] ![Compare how all Medicare Part D PDP plans in WI cover SULFAMETHOXAZOLE-TMP SS TABLET [Septra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFAMYLON 8.5% CREAM (G) ![Compare how all Medicare Part D PDP plans in WI cover SULFAMYLON 8.5% CREAM (G).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SULFASALAZINE 500 MG TABLET [Sulfazine] ![Compare how all Medicare Part D PDP plans in WI cover SULFASALAZINE 500 MG TABLET [Sulfazine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULFASALAZINE DR 500 MG TABLET [Sulfazine EC] ![Compare how all Medicare Part D PDP plans in WI cover SULFASALAZINE DR 500 MG TABLET [Sulfazine EC].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULINDAC 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SULINDAC 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SULINDAC 200 MG TABLET [Clinoril] ![Compare how all Medicare Part D PDP plans in WI cover SULINDAC 200 MG TABLET [Clinoril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUMATRIPTAN 20 MG NASAL SPRAY [Imitrex] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 20 MG NASAL SPRAY [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:12 /30Days |
SUMATRIPTAN 4 MG/0.5 ML INJECT PEN [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 4 MG/0.5 ML INJECT PEN [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
SUMATRIPTAN 4 MG/0.5 ML PEN INJECTOR [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 4 MG/0.5 ML PEN INJECTOR [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
Sumatriptan 5 MG/ACTUAT Nasal Spray ![Compare how all Medicare Part D PDP plans in WI cover Sumatriptan 5 MG/ACTUAT Nasal Spray.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:36 /30Days |
SUMATRIPTAN 6 MG/0.5 ML INJECT ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 6 MG/0.5 ML INJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
SUMATRIPTAN 6 MG/0.5 ML PEN INJCTR [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 6 MG/0.5 ML PEN INJCTR [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
SUMATRIPTAN 6 MG/0.5 ML VIAL [Sumavel DosePro System] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN 6 MG/0.5 ML VIAL [Sumavel DosePro System].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:8 /28Days |
SUMATRIPTAN SUCC 100 MG TABLET [Imitrex] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN SUCC 100 MG TABLET [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:9 /30Days |
SUMATRIPTAN SUCC 25 MG TABLET [Imitrex] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN SUCC 25 MG TABLET [Imitrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:9 /30Days |
SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN SUCC 50 MG TABLET [Migraine Pack].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:9 /30Days |
SUMATRIPTAN-NAPROXEN 85-500 MG Tablet [Treximet] ![Compare how all Medicare Part D PDP plans in WI cover SUMATRIPTAN-NAPROXEN 85-500 MG Tablet [Treximet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:18 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUNITINIB MALATE 12.5 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in WI cover SUNITINIB MALATE 12.5 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SUNITINIB MALATE 25 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in WI cover SUNITINIB MALATE 25 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SUNITINIB MALATE 37.5 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in WI cover SUNITINIB MALATE 37.5 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:56 /28Days |
SUNITINIB MALATE 50 MG CAPSULE [Sutent] ![Compare how all Medicare Part D PDP plans in WI cover SUNITINIB MALATE 50 MG CAPSULE [Sutent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SUNOSI 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SUNOSI 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
SUNOSI 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SUNOSI 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
SUPRAX 100 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WI cover SUPRAX 100 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUPRAX 200 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WI cover SUPRAX 200 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUPRAX 200 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover SUPRAX 200 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUPRAX 500 MG/5 ML SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover SUPRAX 500 MG/5 ML SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUPREP BOWEL PREP KIT SOLUTION RECON ![Compare how all Medicare Part D PDP plans in WI cover SUPREP BOWEL PREP KIT SOLUTION RECON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SUSTIVA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SUSTIVA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUSTIVA 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SUSTIVA 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUSTIVA 600MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SUSTIVA 600MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUTAB 1.479-0.225-0.188 GM TABLET ![Compare how all Medicare Part D PDP plans in WI cover SUTAB 1.479-0.225-0.188 GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SUTENT 12.5MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SUTENT 12.5MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SUTENT 25mg/1 28 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover SUTENT 25mg/1 28 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SUTENT 37.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SUTENT 37.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:56 /28Days |
SUTENT 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SUTENT 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:28 /28Days |
SYEDA 28 TABLET [Zarah] ![Compare how all Medicare Part D PDP plans in WI cover SYEDA 28 TABLET [Zarah].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER ![Compare how all Medicare Part D PDP plans in WI cover SYMBICORT 160-4.5MCG HFA AEROSOL WITH ADAPTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:10 /30Days |
SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER ![Compare how all Medicare Part D PDP plans in WI cover SYMBICORT 80; 4.5ug/1; ug/1 1 POUCH in 1 CARTON / 1 CANISTER in 1 POUCH / 120 AEROSOL in 1 CANISTER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:10 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Symbyax 25; 3mg/1; mg/1 30 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Symbyax 25; 3mg/1; mg/1 30 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SYMBYAX 6-25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SYMBYAX 6-25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | S |
SYMDEKO 100/150 MG-150 MG TABS ![Compare how all Medicare Part D PDP plans in WI cover SYMDEKO 100/150 MG-150 MG TABS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SYMDEKO 50/75 MG-75 MG TABLET SEQ ![Compare how all Medicare Part D PDP plans in WI cover SYMDEKO 50/75 MG-75 MG TABLET SEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SYMFI 600-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYMFI 600-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SYMFI LO 400-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYMFI LO 400-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SYMJEPI 0.15 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SYMJEPI 0.15 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /30Days |
SYMJEPI 0.3 MG/0.3 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover SYMJEPI 0.3 MG/0.3 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4 /30Days |
SYMLINPEN 120 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover SYMLINPEN 120 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:19 /30Days |
SYMLINPEN 60 PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover SYMLINPEN 60 PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:11 /30Days |
SYMPAZAN 10 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover SYMPAZAN 10 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
SYMPAZAN 20 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover SYMPAZAN 20 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
SYMPAZAN 5 MG FILM ![Compare how all Medicare Part D PDP plans in WI cover SYMPAZAN 5 MG FILM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:60 /30Days |
SYMPROIC 0.2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYMPROIC 0.2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
SYMTUZA 800-150-200-10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYMTUZA 800-150-200-10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SYNAREL 2MG/ML NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover SYNAREL 2MG/ML NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
SYNDROS 5 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover SYNDROS 5 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SYNJARDY 12.5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY 12.5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
SYNJARDY 12.5-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY 12.5-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
SYNJARDY 5-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY 5-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
SYNJARDY XR 10-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY XR 10-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
SYNJARDY XR 12.5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY XR 12.5-1,000 MG TABLET BP 24H.](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 |
SYNJARDY XR 25-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY XR 25-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
SYNJARDY XR 5-1,000 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover SYNJARDY XR 5-1,000 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
SYNRIBO 3.5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover SYNRIBO 3.5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
SYNTHROID 100 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 100 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 112 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 112 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 125 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 125 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Synthroid 137ug/1 90 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Synthroid 137ug/1 90 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 150 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 150 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 175 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 175 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 200 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 200 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 25 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 25 MCG TABLET.](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 |
SYNTHROID 300 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 300 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 50 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 50 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 75 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 75 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYNTHROID 88 MCG TABLET ![Compare how all Medicare Part D PDP plans in WI cover SYNTHROID 88 MCG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
SYPRINE 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover SYPRINE 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | Q:240 /30Days |