2023 Medicare Part D Plan Formulary Information |
Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) (H5262-001-0)
Benefit Details
![Email Prescription and/or Health Benefit details for Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO). This function does not email the formulary drug list.](https://q1medicare.com/pics/ContentPics/email_medicare_plan_details.png) Insulin on a Medicare Part D plan's formulary will have a monthly copay of $35 or less. Call drug plan for more details. |
The Gundersen Quartz Med Advantage Elite D (w/Rx) (HMO) (H5262-001-0) Formulary Drugs Starting with the Letter V in Pepin County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter V
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
VALACYCLOVIR HCL 1 GRAM TABLET [Valtrex] ![Compare how all Medicare Part D PDP plans in WI cover VALACYCLOVIR HCL 1 GRAM TABLET [Valtrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VALACYCLOVIR HCL 500 MG TABLET [Valtrex] ![Compare how all Medicare Part D PDP plans in WI cover VALACYCLOVIR HCL 500 MG TABLET [Valtrex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VALCHLOR 0.016% GEL ![Compare how all Medicare Part D PDP plans in WI cover VALCHLOR 0.016% GEL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VALGANCICLOVIR 450 MG TABLET [Valcyte] ![Compare how all Medicare Part D PDP plans in WI cover VALGANCICLOVIR 450 MG TABLET [Valcyte].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | Q:120 /30Days |
VALGANCICLOVIR HCL 50 MG/ML SOLUTION RECON [Valcyte Powder] ![Compare how all Medicare Part D PDP plans in WI cover VALGANCICLOVIR HCL 50 MG/ML SOLUTION RECON [Valcyte Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VALPROIC ACID 250 MG CAPSULE [Depakene] ![Compare how all Medicare Part D PDP plans in WI cover VALPROIC ACID 250 MG CAPSULE [Depakene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VALPROIC ACID 250 MG/5 ML SOLUTION [Depakene] ![Compare how all Medicare Part D PDP plans in WI cover VALPROIC ACID 250 MG/5 ML SOLUTION [Depakene].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VALSARTAN 160 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN 160 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN 320 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN 320 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN 4 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN 4 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VALSARTAN 40 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN 40 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN 80 MG TABLET [Diovan] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN 80 MG TABLET [Diovan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN-HCTZ 160-12.5 MG TABLET [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN-HCTZ 160-25 MG TABLET [Diovan HCT] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN-HCTZ 160-25 MG TABLET [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN-HCTZ 320-12.5 MG TABLET [Diovan HCT] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN-HCTZ 320-12.5 MG TABLET [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN-HCTZ 320-25 MG TABLET [Diovan HCT] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN-HCTZ 320-25 MG TABLET [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALSARTAN-HCTZ 80-12.5 MG TABLET [Diovan HCT] ![Compare how all Medicare Part D PDP plans in WI cover VALSARTAN-HCTZ 80-12.5 MG TABLET [Diovan HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VALTOCO 10 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover VALTOCO 10 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $113.00 | P Q:10 /30Days |
VALTOCO 15 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover VALTOCO 15 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $113.00 | P Q:10 /30Days |
VALTOCO 20 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover VALTOCO 20 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $113.00 | P Q:10 /30Days |
VALTOCO 5 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover VALTOCO 5 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $113.00 | P Q:10 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VANCOMYCIN 1 GM VIAL [Vancocin] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN 1 GM VIAL [Vancocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN 25 MG/ML ORAL SOLUTION RECON [FIRVANQ] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN 25 MG/ML ORAL SOLUTION RECON [FIRVANQ].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN 250 MG/5 ML SOLUTION SOLUTION RECON [Vancocin] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN 250 MG/5 ML SOLUTION SOLUTION RECON [Vancocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN HCL 10 GM VIAL [Vancocin] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 10 GM VIAL [Vancocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN HCL 125 MG CAPSULE [Vancocin] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 125 MG CAPSULE [Vancocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANCOMYCIN HCL 250 MG CAPSULE [Vancocin] ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 250 MG CAPSULE [Vancocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VANCOMYCIN HCL 750 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover VANCOMYCIN HCL 750 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VANDAZOLE 0.75% GEL WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in WI cover VANDAZOLE 0.75% GEL WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $113.00 | None |
VAQTA 25 UNITS/0.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover VAQTA 25 UNITS/0.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
VAQTA 50 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover VAQTA 50 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VAQTA 50 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover VAQTA 50 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
Vaqta Hepatitis A Vaccine Pediatric / Adolescent 25 Unit / 0.5 mL Injection Single Dose Vial 0.5 mL ![Compare how all Medicare Part D PDP plans in WI cover Vaqta Hepatitis A Vaccine Pediatric / Adolescent 25 Unit / 0.5 mL Injection Single Dose Vial 0.5 mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
VARENICLINE 0.5 MG TABLET [Chantix] ![Compare how all Medicare Part D PDP plans in WI cover VARENICLINE 0.5 MG TABLET [Chantix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | Q:60 /30Days |
VARENICLINE 1 MG TABLET [Chantix] ![Compare how all Medicare Part D PDP plans in WI cover VARENICLINE 1 MG TABLET [Chantix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | Q:60 /30Days |
VARENICLINE STARTING MONTH BOX TABLET DS PK [Chantix] ![Compare how all Medicare Part D PDP plans in WI cover VARENICLINE STARTING MONTH BOX TABLET DS PK [Chantix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | Q:53 /28Days |
VARIVAX VACCINE W/DILUENT ![Compare how all Medicare Part D PDP plans in WI cover VARIVAX VACCINE W/DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | Q:2 /365Days |
VELIVET 28 DAY TABLET ![Compare how all Medicare Part D PDP plans in WI cover VELIVET 28 DAY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VELPHORO 500 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VELPHORO 500 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
VELTASSA 16.8 GM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover VELTASSA 16.8 GM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
VELTASSA 25.2 GM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover VELTASSA 25.2 GM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
VELTASSA 8.4 GM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover VELTASSA 8.4 GM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VEMLIDY 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VEMLIDY 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VENCLEXTA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENCLEXTA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
VENCLEXTA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENCLEXTA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:180 /30Days |
VENCLEXTA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VENCLEXTA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VENCLEXTA STARTING PACK ![Compare how all Medicare Part D PDP plans in WI cover VENCLEXTA STARTING PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VENLAFAXINE BESYLATE ER 112.5 MG TABLET 24H ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE BESYLATE ER 112.5 MG TABLET 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:60 /30Days |
VENLAFAXINE HCL 100 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 100 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL 25 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 25 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL 37.5 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 37.5 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL 50 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 50 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL 75 MG TABLET [Effexor] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL 75 MG TABLET [Effexor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VENLAFAXINE HCL ER 150 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL ER 150 MG CAPSULE 24H [Effexor XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL ER 37.5 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL ER 37.5 MG CAPSULE 24H [Effexor XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VENLAFAXINE HCL ER 75 MG CAPSULE 24H [Effexor XR] ![Compare how all Medicare Part D PDP plans in WI cover VENLAFAXINE HCL ER 75 MG CAPSULE 24H [Effexor XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
Ventavis 0.02mg/mL ![Compare how all Medicare Part D PDP plans in WI cover Ventavis 0.02mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:270 /30Days |
VENTAVIS 10 MCG/1 ML SOLUTION AMPUL-NEB ![Compare how all Medicare Part D PDP plans in WI cover VENTAVIS 10 MCG/1 ML SOLUTION AMPUL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:270 /30Days |
VERAPAMIL 120 MG TABLET [Calan] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 120 MG TABLET [Calan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VERAPAMIL 40 MG TABLET [Isoptin SR] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 40 MG TABLET [Isoptin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VERAPAMIL 80 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VERAPAMIL ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VERAPAMIL ER 180 MG TABLET [Isoptin SR] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 180 MG TABLET [Isoptin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VERAPAMIL ER 240 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER 240 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERAPAMIL ER PM 100 MG CAPSULE 24H PCT [Verelan PM] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER PM 100 MG CAPSULE 24H PCT [Verelan PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL ER PM 200 MG CAPSULE 24H PCT [Verelan PM] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER PM 200 MG CAPSULE 24H PCT [Verelan PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL ER PM 300 MG CAPSULE 24H PCT [Verelan PM] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL ER PM 300 MG CAPSULE 24H PCT [Verelan PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL HCL 360MG CAPSULES SUSTAINED RELEASE ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL HCL 360MG CAPSULES SUSTAINED RELEASE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL SR 120 MG CAPSULE 24H PEL [Verelan] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL SR 120 MG CAPSULE 24H PEL [Verelan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL SR 180 MG CAPSULE 24H PEL [Verelan] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL SR 180 MG CAPSULE 24H PEL [Verelan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERAPAMIL SR 240 MG CAPSULE 24H PEL [Verelan] ![Compare how all Medicare Part D PDP plans in WI cover VERAPAMIL SR 240 MG CAPSULE 24H PEL [Verelan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | None |
VERDESO 0.05% FOAM ![Compare how all Medicare Part D PDP plans in WI cover VERDESO 0.05% FOAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
VEREGEN 15% OINTMENT ![Compare how all Medicare Part D PDP plans in WI cover VEREGEN 15% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VERKAZIA 0.1% EYE EMULSION DROPERETTE ![Compare how all Medicare Part D PDP plans in WI cover VERKAZIA 0.1% EYE EMULSION DROPERETTE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
VERQUVO 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERQUVO 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VERQUVO 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERQUVO 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
VERQUVO 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERQUVO 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:30 /30Days |
VERSACLOZ 50 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover VERSACLOZ 50 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:540 /30Days |
VERZENIO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERZENIO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VERZENIO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERZENIO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VERZENIO 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERZENIO 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VERZENIO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VERZENIO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VESTURA 3 MG-0.02 MG TABLET [Yaz] ![Compare how all Medicare Part D PDP plans in WI cover VESTURA 3 MG-0.02 MG TABLET [Yaz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VIBERZI 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIBERZI 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VIBERZI 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIBERZI 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VIBRAMYCIN 50 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover VIBRAMYCIN 50 MG/5 ML SYRUP.](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 |
VIENVA-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in WI cover VIENVA-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VIGABATRIN 500 MG POWDER PACK [VIGADRONE] ![Compare how all Medicare Part D PDP plans in WI cover VIGABATRIN 500 MG POWDER PACK [VIGADRONE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:180 /30Days |
VIGABATRIN 500 MG TABLET [Sabril] ![Compare how all Medicare Part D PDP plans in WI cover VIGABATRIN 500 MG TABLET [Sabril].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:180 /30Days |
VIGADRONE 500 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover VIGADRONE 500 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:180 /30Days |
VIIBRYD 10-20 MG STARTER PACK ![Compare how all Medicare Part D PDP plans in WI cover VIIBRYD 10-20 MG STARTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:30 /22Days |
VILAZODONE HCL 10 MG TABLET [VIIBRYD] ![Compare how all Medicare Part D PDP plans in WI cover VILAZODONE HCL 10 MG TABLET [VIIBRYD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VILAZODONE HCL 20 MG TABLET [VIIBRYD] ![Compare how all Medicare Part D PDP plans in WI cover VILAZODONE HCL 20 MG TABLET [VIIBRYD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VILAZODONE HCL 40 MG TABLET [VIIBRYD] ![Compare how all Medicare Part D PDP plans in WI cover VILAZODONE HCL 40 MG TABLET [VIIBRYD].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VIRACEPT 250MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIRACEPT 250MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:300 /30Days |
VIRACEPT 625MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIRACEPT 625MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:120 /30Days |
VIREAD 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VIREAD 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
VIREAD 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIREAD 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:30 /30Days |
VIREAD POWDER ![Compare how all Medicare Part D PDP plans in WI cover VIREAD POWDER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | None |
VITRAKVI 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VITRAKVI 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:60 /30Days |
VITRAKVI 20 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover VITRAKVI 20 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:300 /30Days |
VITRAKVI 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VITRAKVI 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:240 /30Days |
VIVITROL INJECTABLE SUSPENSION 380MG/VIAL ![Compare how all Medicare Part D PDP plans in WI cover VIVITROL INJECTABLE SUSPENSION 380MG/VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | Q:1 /28Days |
VIVJOA 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VIVJOA 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P Q:18 /84Days |
VIZIMPRO 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIZIMPRO 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VIZIMPRO 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIZIMPRO 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VIZIMPRO 45 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VIZIMPRO 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VONJO 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VONJO 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
VORICONAZOLE 200 MG TABLET [VFEND] ![Compare how all Medicare Part D PDP plans in WI cover VORICONAZOLE 200 MG TABLET [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | P Q:120 /30Days |
VORICONAZOLE 200 MG VIAL [VFEND] ![Compare how all Medicare Part D PDP plans in WI cover VORICONAZOLE 200 MG VIAL [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P |
VORICONAZOLE 40 MG/ML ORAL SUSPENSION [VFEND] ![Compare how all Medicare Part D PDP plans in WI cover VORICONAZOLE 40 MG/ML ORAL SUSPENSION [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | P |
VORICONAZOLE 50 MG TABLET [VFEND] ![Compare how all Medicare Part D PDP plans in WI cover VORICONAZOLE 50 MG TABLET [VFEND].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$15.00 | $38.00 | P Q:120 /30Days |
VOSEVI 400-100-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VOSEVI 400-100-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VOTRIENT 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover VOTRIENT 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
VOWST CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VOWST CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:12 /3Days |
VRAYLAR 1.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VRAYLAR 1.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:30 /30Days |
VRAYLAR 1.5 MG-3 MG PACK ![Compare how all Medicare Part D PDP plans in WI cover VRAYLAR 1.5 MG-3 MG PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | S Q:7 /7Days |
VRAYLAR 3 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VRAYLAR 3 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VRAYLAR 4.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VRAYLAR 4.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:30 /30Days |
VRAYLAR 6 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VRAYLAR 6 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | S Q:30 /30Days |
VUITY 1.25% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover VUITY 1.25% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:5 /28Days |
VYFEMLA 0.4 MG-0.035 MG TABLET [Zenchent] ![Compare how all Medicare Part D PDP plans in WI cover VYFEMLA 0.4 MG-0.035 MG TABLET [Zenchent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VYLIBRA 28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYLIBRA 28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $5.00 | None |
VYNDAMAX 61 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYNDAMAX 61 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:30 /30Days |
VYNDAQEL 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYNDAQEL 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
33% | N/A | P Q:120 /30Days |
VYVANSE 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 10 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 10 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 20 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 20 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 30 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 30 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
VYVANSE 30MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 30MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 40 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 40 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 40MG CAPSULE 100 EA ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 40MG CAPSULE 100 EA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 50 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 50 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 60 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 60 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE 70MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE 70MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE CAPSULES 20MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE CAPSULES 20MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYVANSE CAPSULES 60MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover VYVANSE CAPSULES 60MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:30 /30Days |
VYZULTA 0.024% OPHTH SOLUTION DROPS ![Compare how all Medicare Part D PDP plans in WI cover VYZULTA 0.024% OPHTH SOLUTION DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |