2024 Medicare Part D Plan Formulary Information |
Network Health Cares (PPO D-SNP) (H5215-007-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Network Health Cares (PPO D-SNP). 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 Network Health Cares (PPO D-SNP) (H5215-007-0) Formulary Drugs Starting with the Letter D in Kewaunee County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter D
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
DABIGATRAN ETEXILATE 110 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in WI cover DABIGATRAN ETEXILATE 110 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DABIGATRAN ETEXILATE 150 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in WI cover DABIGATRAN ETEXILATE 150 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DABIGATRAN ETEXILATE 75 MG CAPSULE [Pradaxa] ![Compare how all Medicare Part D PDP plans in WI cover DABIGATRAN ETEXILATE 75 MG CAPSULE [Pradaxa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DALFAMPRIDINE ER 10 MG TABLET 12H [Ampyra] ![Compare how all Medicare Part D PDP plans in WI cover DALFAMPRIDINE ER 10 MG TABLET 12H [Ampyra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | P Q:60 /30Days |
DALVANCE 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover DALVANCE 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DANAZOL 100 MG CAPSULE [Danocrine] ![Compare how all Medicare Part D PDP plans in WI cover DANAZOL 100 MG CAPSULE [Danocrine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DANAZOL 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DANAZOL 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DANAZOL CAPSULES USP 200MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover DANAZOL CAPSULES USP 200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DANTROLENE SODIUM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DANTROLENE SODIUM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DANTROLENE SODIUM 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DANTROLENE SODIUM 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DANTROLENE SODIUM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DANTROLENE SODIUM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DAPAGLIFLOZIN 10 MG TABLET [Farxiga] ![Compare how all Medicare Part D PDP plans in WI cover DAPAGLIFLOZIN 10 MG TABLET [Farxiga].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
DAPAGLIFLOZIN 5 MG TABLET [Farxiga] ![Compare how all Medicare Part D PDP plans in WI cover DAPAGLIFLOZIN 5 MG TABLET [Farxiga].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
DAPAGLIFLOZIN-METFOR ER 10-1000 TABLET BP 24H [Xigduo XR] ![Compare how all Medicare Part D PDP plans in WI cover DAPAGLIFLOZIN-METFOR ER 10-1000 TABLET BP 24H [Xigduo XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
DAPAGLIFLOZIN-METFOR ER 5-1000 TABLET BP 24H [Xigduo XR] ![Compare how all Medicare Part D PDP plans in WI cover DAPAGLIFLOZIN-METFOR ER 5-1000 TABLET BP 24H [Xigduo XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
DAPSONE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAPSONE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DAPSONE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAPSONE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DAPSONE 5% GEL [Aczone] ![Compare how all Medicare Part D PDP plans in WI cover DAPSONE 5% GEL [Aczone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DAPSONE 7.5% GEL W/PUMP [Aczone] ![Compare how all Medicare Part D PDP plans in WI cover DAPSONE 7.5% GEL W/PUMP [Aczone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DAPTACEL DTAP VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover DAPTACEL DTAP VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DAPTOMYCIN 350 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in WI cover DAPTOMYCIN 350 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DAPTOMYCIN 500 MG VIAL [Cubicin RF] ![Compare how all Medicare Part D PDP plans in WI cover DAPTOMYCIN 500 MG VIAL [Cubicin RF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DARIFENACIN ER 15 MG TABLET ER 24H [Enablex] ![Compare how all Medicare Part D PDP plans in WI cover DARIFENACIN ER 15 MG TABLET ER 24H [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DARIFENACIN ER 7.5 MG TABLET ER 24H [Enablex] ![Compare how all Medicare Part D PDP plans in WI cover DARIFENACIN ER 7.5 MG TABLET ER 24H [Enablex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DARUNAVIR 600 MG TABLET [Prezista] ![Compare how all Medicare Part D PDP plans in WI cover DARUNAVIR 600 MG TABLET [Prezista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DARUNAVIR 800 MG TABLET [Prezista] ![Compare how all Medicare Part D PDP plans in WI cover DARUNAVIR 800 MG TABLET [Prezista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DAURISMO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAURISMO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:30 /30Days |
DAURISMO 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAURISMO 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:60 /30Days |
DAYBUE 200 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DAYBUE 200 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DAYTRANA PATCH 1.1 MG/HR ![Compare how all Medicare Part D PDP plans in WI cover DAYTRANA PATCH 1.1 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DAYTRANA PATCH 1.6 MG/HR ![Compare how all Medicare Part D PDP plans in WI cover DAYTRANA PATCH 1.6 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DAYTRANA PATCH 2.2 MG/HR ![Compare how all Medicare Part D PDP plans in WI cover DAYTRANA PATCH 2.2 MG/HR.](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 |
DAYTRANA PATCH 3.3 MG/HR ![Compare how all Medicare Part D PDP plans in WI cover DAYTRANA PATCH 3.3 MG/HR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DAYVIGO 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAYVIGO 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:30 /30Days |
DAYVIGO 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DAYVIGO 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:30 /30Days |
DEBLITANE 0.35 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEBLITANE 0.35 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEFERASIROX 125 MG TB FOR SUSPENSION TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 125 MG TB FOR SUSPENSION TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DEFERASIROX 180 MG GRANULE PACK [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 180 MG GRANULE PACK [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 180 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 180 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 250 MG TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 250 MG TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 360 MG GRANULE PACK [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 360 MG GRANULE PACK [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 360 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 360 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 500 MG TB FOR SUSPENSION TABLET DISPER [Exjade] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 500 MG TB FOR SUSPENSION TABLET DISPER [Exjade].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEFERASIROX 90 MG GRANULE PACK [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 90 MG GRANULE PACK [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERASIROX 90 MG TABLET [Jadenu] ![Compare how all Medicare Part D PDP plans in WI cover DEFERASIROX 90 MG TABLET [Jadenu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DEFERIPRONE 1,000 MG TABLET (3X/DY) [Ferriprox] ![Compare how all Medicare Part D PDP plans in WI cover DEFERIPRONE 1,000 MG TABLET (3X/DY) [Ferriprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DEFERIPRONE 500 MG TABLET [Ferriprox] ![Compare how all Medicare Part D PDP plans in WI cover DEFERIPRONE 500 MG TABLET [Ferriprox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DELSTRIGO 100-300-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DELSTRIGO 100-300-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DEMECLOCYCLINE 150 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in WI cover DEMECLOCYCLINE 150 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEMECLOCYCLINE 300 MG TABLET [Declomycin] ![Compare how all Medicare Part D PDP plans in WI cover DEMECLOCYCLINE 300 MG TABLET [Declomycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEPO-ESTRADIOL 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover DEPO-ESTRADIOL 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover Depo-SubQ Provera 104mg/0.65mL 0.65 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DESCOVY 120-15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DESCOVY 120-15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DESCOVY 200-25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DESCOVY 200-25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESIPRAMINE 10 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 10 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESIPRAMINE 100 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 100 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESIPRAMINE 150 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 150 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESIPRAMINE 25 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 25 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESIPRAMINE 50 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 50 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESIPRAMINE 75 MG TABLET [Norpramin] ![Compare how all Medicare Part D PDP plans in WI cover DESIPRAMINE 75 MG TABLET [Norpramin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESLORATADINE 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DESLORATADINE 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESMOPRESSIN 0.01% SOLUTION SPRAY/PUMP [Minirin] ![Compare how all Medicare Part D PDP plans in WI cover DESMOPRESSIN 0.01% SOLUTION SPRAY/PUMP [Minirin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in WI cover DESMOPRESSIN ACETATE 0.1 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP] ![Compare how all Medicare Part D PDP plans in WI cover DESMOPRESSIN ACETATE 0.2 MG TABLET [DDAVP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea] ![Compare how all Medicare Part D PDP plans in WI cover DESOGESTR-ETH ESTRAD ETH ESTRA TABLET [Volnea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover DESOGESTREL-EE 0.15-0.03 MG TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESONIDE 0.05% CREAM (G) [Tridesilon] ![Compare how all Medicare Part D PDP plans in WI cover DESONIDE 0.05% CREAM (G) [Tridesilon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESONIDE 0.05% LOTION [LoKara] ![Compare how all Medicare Part D PDP plans in WI cover DESONIDE 0.05% LOTION [LoKara].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESONIDE 0.05% OINTMENT [Tridesilon] ![Compare how all Medicare Part D PDP plans in WI cover DESONIDE 0.05% OINTMENT [Tridesilon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESOXIMETASONE 0.05% CREAM (G) [Topicort LP] ![Compare how all Medicare Part D PDP plans in WI cover DESOXIMETASONE 0.05% CREAM (G) [Topicort LP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESOXIMETASONE 0.05% OINTMENT [Topicort LP] ![Compare how all Medicare Part D PDP plans in WI cover DESOXIMETASONE 0.05% OINTMENT [Topicort LP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESOXIMETASONE 0.25% CREAM (G) [Topicort] ![Compare how all Medicare Part D PDP plans in WI cover DESOXIMETASONE 0.25% CREAM (G) [Topicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESOXIMETASONE 0.25% OINTMENT [Topicort] ![Compare how all Medicare Part D PDP plans in WI cover DESOXIMETASONE 0.25% OINTMENT [Topicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESOXIMETASONE 0.25% SPRAY [Topicort] ![Compare how all Medicare Part D PDP plans in WI cover DESOXIMETASONE 0.25% SPRAY [Topicort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in WI cover Desoximetasone 0.5mg/g 1 TUBE per CARTON / 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESVENLAFAXINE ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DESVENLAFAXINE ER 100 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 |
DESVENLAFAXINE ER 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DESVENLAFAXINE ER 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DESVENLAFAXINE SUCCNT ER 100MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in WI cover DESVENLAFAXINE SUCCNT ER 100MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESVENLAFAXINE SUCCNT ER 25 MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in WI cover DESVENLAFAXINE SUCCNT ER 25 MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DESVENLAFAXINE SUCCNT ER 50 MG TABLET 24H [Pristiq] ![Compare how all Medicare Part D PDP plans in WI cover DESVENLAFAXINE SUCCNT ER 50 MG TABLET 24H [Pristiq].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 0.1% EYE DROP ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 0.1% EYE DROP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 0.5 MG/5 ML LIQ SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 0.5 MG/5 ML LIQ SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 0.75MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 0.75MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 1.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 1.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 1MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 2MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 2MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXAMETHASONE 4MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 4MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXAMETHASONE 6MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXAMETHASONE 6MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXLANSOPRAZOLE DR 30 MG CAPSULE DR BP [Kapidex] ![Compare how all Medicare Part D PDP plans in WI cover DEXLANSOPRAZOLE DR 30 MG CAPSULE DR BP [Kapidex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:30 /30Days |
DEXLANSOPRAZOLE DR 60 MG CAPSULE DR BP [Kapidex] ![Compare how all Medicare Part D PDP plans in WI cover DEXLANSOPRAZOLE DR 60 MG CAPSULE DR BP [Kapidex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:30 /30Days |
DEXMETHYLPHENIDATE 10 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE 10 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE 2.5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE 5 MG TABLET [Focalin] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE 5 MG TABLET [Focalin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE ER 10 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 10 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXMETHYLPHENIDATE ER 15 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 15 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE ER 20 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 20 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXMETHYLPHENIDATE ER 25 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 25 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXMETHYLPHENIDATE ER 30 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 30 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE ER 35 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 35 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE ER 40 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 40 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXMETHYLPHENIDATE ER 5 MG CAPSULE CPBP 50-50 [Focalin XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXMETHYLPHENIDATE ER 5 MG CAPSULE CPBP 50-50 [Focalin XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMP-AMPHET ER 10 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 10 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHET ER 15 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 15 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHET ER 20 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 20 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHET ER 25 MG CAPSULE 24H [Mydayis] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 25 MG CAPSULE 24H [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHET ER 30 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 30 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHET ER 5 MG CAPSULE 24H [Adderall XR] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHET ER 5 MG CAPSULE 24H [Adderall XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMP-AMPHETAMIN 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHETAMIN 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMP-AMPHETAMIN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMP-AMPHETAMIN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPH-AMPHET ER 12.5MG CAPSULE CPTP 24HR [Mydayis] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPH-AMPHET ER 12.5MG CAPSULE CPTP 24HR [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPH-AMPHET ER 25 MG CAPSULE CPTP 24HR [Mydayis] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPH-AMPHET ER 25 MG CAPSULE CPTP 24HR [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPH-AMPHET ER 37.5MG CAPSULE CPTP 24HR [Mydayis] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPH-AMPHET ER 37.5MG CAPSULE CPTP 24HR [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPH-AMPHET ER 50 MG CAPSULE CPTP 24HR [Mydayis] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPH-AMPHET ER 50 MG CAPSULE CPTP 24HR [Mydayis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 10 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE 15 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 15 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE 20 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 20 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE 30 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 30 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 5 MG TABLET [Zenzedi].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE 5 MG/5 ML SOLUTION [ProCentra] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE 5 MG/5 ML SOLUTION [ProCentra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DEXTROAMPHETAMINE ER 10 MG CAPSULE [Dexedrine Spansule] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE ER 10 MG CAPSULE [Dexedrine Spansule].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPHETAMINE ER 15 MG CAPSULE [Dexedrine Spansule] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE ER 15 MG CAPSULE [Dexedrine Spansule].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROAMPHETAMINE ER 5 MG CAPSULE [Dexedrine Spansule] ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE ER 5 MG CAPSULE [Dexedrine Spansule].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover DEXTROAMPHETAMINE SACCHARATE AND SULFATE AMPHETAMINE ASPARTATE 10MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DEXTROSE 10%-1/4NS IV TUBEX ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 10%-1/4NS IV TUBEX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 10%-WATER IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 10%-WATER IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 2.5%-1/2NS IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 2.5%-1/2NS IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 5%-0.2% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 5%-0.2% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 5%-0.45% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 5%-0.45% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 5%-0.9% NACL IV SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 5%-0.9% NACL IV SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DEXTROSE 5%-WATER IV SOLUTION PGY VL PRT ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE 5%-WATER IV SOLUTION PGY VL PRT.](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 |
DEXTROSE IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover DEXTROSE IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DIACOMIT 250 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DIACOMIT 250 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DIACOMIT 250 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in WI cover DIACOMIT 250 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DIACOMIT 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DIACOMIT 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DIACOMIT 500 MG POWDER PACK ![Compare how all Medicare Part D PDP plans in WI cover DIACOMIT 500 MG POWDER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 10 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIAZEPAM 10 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 10 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIAZEPAM 2 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 2 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 2.5 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 20 MG RECTAL GEL SYST KIT [Diastat].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIAZEPAM 5 MG TABLET [Valium] ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 5 MG TABLET [Valium].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIAZEPAM 5 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 5 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIAZEPAM 5 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in WI cover DIAZEPAM 5 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem] ![Compare how all Medicare Part D PDP plans in WI cover DIAZOXIDE 50 MG/ML ORAL SUSPENSION [Proglycem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DICLOFENAC 0.1% EYE DROPS [Voltaren Ophthalmic] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC 0.1% EYE DROPS [Voltaren Ophthalmic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC POT 50 MG TABLET [Cataflam] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC POT 50 MG TABLET [Cataflam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC POTASSIUM 50 MG POWDER PACKET [Cambia] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC POTASSIUM 50 MG POWDER PACKET [Cambia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:9 /30Days |
DICLOFENAC SOD EC 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SOD EC 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC SOD EC 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SOD EC 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC SOD EC 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SOD EC 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SOD ER 100 MG TABLET ER 24H [Voltaren-XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOFENAC SODIUM 1% GEL [Voltaren Gel] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SODIUM 1% GEL [Voltaren Gel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DICLOFENAC SODIUM 3% GEL [Solaraze] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC SODIUM 3% GEL [Solaraze].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:100 /30Days |
DICLOFENAC-MISOPROST 50-200 TABLET IR DR [Arthrotec] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC-MISOPROST 50-200 TABLET IR DR [Arthrotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DICLOFENAC-MISOPROST 75-200 TABLET IR DR [Arthrotec] ![Compare how all Medicare Part D PDP plans in WI cover DICLOFENAC-MISOPROST 75-200 TABLET IR DR [Arthrotec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DICLOXACILLIN 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DICLOXACILLIN 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICLOXACILLIN SODIUM 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DICLOXACILLIN SODIUM 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DICYCLOMINE 10 MG CAPSULE [Bentyl] ![Compare how all Medicare Part D PDP plans in WI cover DICYCLOMINE 10 MG CAPSULE [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DICYCLOMINE 20 MG TABLET [Bentyl] ![Compare how all Medicare Part D PDP plans in WI cover DICYCLOMINE 20 MG TABLET [Bentyl].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DICYCLOMINE HCL 10MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover DICYCLOMINE HCL 10MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Dificid 200mg/1 1 BOTTLE per CARTON / 20 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:20 /10Days |
DIFICID 40 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover DIFICID 40 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:136 /10Days |
DIFLUNISAL 500 MG TABLET [Dolobid] ![Compare how all Medicare Part D PDP plans in WI cover DIFLUNISAL 500 MG TABLET [Dolobid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIFLUPREDNATE 0.05% EYE DROPS [Durezol] ![Compare how all Medicare Part D PDP plans in WI cover DIFLUPREDNATE 0.05% EYE DROPS [Durezol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin] ![Compare how all Medicare Part D PDP plans in WI cover DIGOXIN 0.05 MG/ML SOLUTION [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIGOXIN 125 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in WI cover DIGOXIN 125 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIGOXIN 250 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in WI cover DIGOXIN 250 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIGOXIN 62.5 MCG TABLET [Lanoxin] ![Compare how all Medicare Part D PDP plans in WI cover DIGOXIN 62.5 MCG TABLET [Lanoxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIHYDROERGOTAMINE 4 MG/ML SPRAY/PUMP [TRUDHESA] ![Compare how all Medicare Part D PDP plans in WI cover DIHYDROERGOTAMINE 4 MG/ML SPRAY/PUMP [TRUDHESA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | Q:8 /28Days |
DILANTIN CAPSULES 30 MG ER ![Compare how all Medicare Part D PDP plans in WI cover DILANTIN CAPSULES 30 MG ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | P |
DILT XR 120 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DILT XR 120 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILT XR 180 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DILT XR 180 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILT XR 240 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DILT XR 240 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 120 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 120 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 12HR ER 120 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 12HR ER 60 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 12HR ER 90 MG CAPSULE [Cardizem SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 120 MG TABLET [Cardizem LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 120 MG TABLET [Cardizem LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 180 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 180 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 240 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 240 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 300 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 300 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 360 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 360 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER (LA) 420 MG TABLET [Matzim LA] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER (LA) 420 MG TABLET [Matzim LA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER(CD) 120 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER(CD) 120 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER(CD) 180 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER(CD) 180 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DILTIAZEM 24H ER(CD) 240 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER(CD) 240 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24H ER(CD) 300 MG CAPSULE ER 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24H ER(CD) 300 MG CAPSULE ER 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24HR ER 360 MG CAPSULE SA 24H [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 24HR ER 420 MG CAPSULE [Tiazac].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 30 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 30 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 60 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 60 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DILTIAZEM 90 MG TABLET [Cardizem] ![Compare how all Medicare Part D PDP plans in WI cover DILTIAZEM 90 MG TABLET [Cardizem].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in WI cover DIMETHYL FUMARATE 30D START PK CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in WI cover DIMETHYL FUMARATE DR 120 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera] ![Compare how all Medicare Part D PDP plans in WI cover DIMETHYL FUMARATE DR 240 MG CAPSULE DR [Tecfidera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix] ![Compare how all Medicare Part D PDP plans in WI cover Diph-Tetanus Tox-Acell Pert adsorbed and IPV vaccine 0.5 ML Prefilled Syringe [Kinrix].](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 |
Diph-Tetanus Tox-Acell Pert-Hepatitis B-Polio IPV Vac 0.5 ML Prefilled Syringe [Pediarix] ![Compare how all Medicare Part D PDP plans in WI cover Diph-Tetanus Tox-Acell Pert-Hepatitis B-Polio IPV Vac 0.5 ML Prefilled Syringe [Pediarix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro] ![Compare how all Medicare Part D PDP plans in WI cover DIPHENOXYLATE-ATROP 2.5-0.025 TABLET [Vi-Atro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DIPHENOXYLATE/ATROPINE LIQ ![Compare how all Medicare Part D PDP plans in WI cover DIPHENOXYLATE/ATROPINE LIQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension ![Compare how all Medicare Part D PDP plans in WI cover Diphtheria Toxoid Vaccine 25 UNT/ML / Tetanus Toxoid Vaccine 5 UNT per 0.5 ML Injectable Suspension.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIPYRIDAMOLE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DIPYRIDAMOLE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIPYRIDAMOLE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DIPYRIDAMOLE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DIPYRIDAMOLE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DIPYRIDAMOLE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DISOPYRAMIDE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DISOPYRAMIDE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover DISOPYRAMIDE PHOSPHATE 150MG CAPSULE USP (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DISULFIRAM 250 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DISULFIRAM 250 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DISULFIRAM 500 MG TABLET [Antabuse] ![Compare how all Medicare Part D PDP plans in WI cover DISULFIRAM 500 MG TABLET [Antabuse].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DIURIL 250MG/5ML SUSPENSION ORAL ![Compare how all Medicare Part D PDP plans in WI cover DIURIL 250MG/5ML SUSPENSION ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DIVALPROEX DR 125 MG CAPSULE SPRNK ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX DR 125 MG CAPSULE SPRNK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIVALPROEX SOD DR 125 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX SOD DR 125 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIVALPROEX SOD DR 250 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX SOD DR 250 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIVALPROEX SOD DR 500 MG TABLET DR [Depakote] ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX SOD DR 500 MG TABLET DR [Depakote].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIVALPROEX SOD ER 250 MG TABLET 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX SOD ER 250 MG TABLET 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER] ![Compare how all Medicare Part D PDP plans in WI cover DIVALPROEX SOD ER 500 MG TABLET ER 24H [Depakote ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOFETILIDE 125 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in WI cover DOFETILIDE 125 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOFETILIDE 250 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in WI cover DOFETILIDE 250 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOFETILIDE 500 MCG CAPSULE [Tikosyn] ![Compare how all Medicare Part D PDP plans in WI cover DOFETILIDE 500 MCG CAPSULE [Tikosyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOLISHALE 90-20 MCG TABLET [Lybrel] ![Compare how all Medicare Part D PDP plans in WI cover DOLISHALE 90-20 MCG TABLET [Lybrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DONEPEZIL HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DONEPEZIL HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$7.00 | $0.00 | None |
DONEPEZIL HCL 23 MG TABLET [Aricept] ![Compare how all Medicare Part D PDP plans in WI cover DONEPEZIL HCL 23 MG TABLET [Aricept].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DONEPEZIL HCL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DONEPEZIL HCL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$7.00 | $0.00 | None |
DONEPEZIL HCL ODT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DONEPEZIL HCL ODT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$7.00 | $0.00 | None |
DONEPEZIL HCL ODT 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DONEPEZIL HCL ODT 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$7.00 | $0.00 | None |
DOPTELET 20 MG (30 TABLET PK) ![Compare how all Medicare Part D PDP plans in WI cover DOPTELET 20 MG (30 TABLET PK).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DOPTELET 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOPTELET 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DOPTELET 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOPTELET 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P |
DORZOLAMIDE HCL 2% EYE DROPS [Trusopt] ![Compare how all Medicare Part D PDP plans in WI cover DORZOLAMIDE HCL 2% EYE DROPS [Trusopt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DORZOLAMIDE-TIMOLOL 2%-0.5% DROPERETTE [Cosopt PF] ![Compare how all Medicare Part D PDP plans in WI cover DORZOLAMIDE-TIMOLOL 2%-0.5% DROPERETTE [Cosopt PF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DORZOLAMIDE-TIMOLOL EYE DROPS [Cosopt PF] ![Compare how all Medicare Part D PDP plans in WI cover DORZOLAMIDE-TIMOLOL EYE DROPS [Cosopt PF].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$7.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover DOTTI 0.025 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover DOTTI 0.0375 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover DOTTI 0.05 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover DOTTI 0.075 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot] ![Compare how all Medicare Part D PDP plans in WI cover DOTTI 0.1 MG PATCH TDSW [Vivelle-Dot].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOVATO 50-300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOVATO 50-300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | None |
DOXAZOSIN MESYLATE 1 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in WI cover DOXAZOSIN MESYLATE 1 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXAZOSIN MESYLATE 2 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in WI cover DOXAZOSIN MESYLATE 2 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXAZOSIN MESYLATE 4 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in WI cover DOXAZOSIN MESYLATE 4 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXAZOSIN MESYLATE 8 MG TABLET [Cardura] ![Compare how all Medicare Part D PDP plans in WI cover DOXAZOSIN MESYLATE 8 MG TABLET [Cardura].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXEPIN 10 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 10 MG CAPSULE [Sinequan].](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 |
DOXEPIN 10 MG/ML ORAL CONC [Sinequan] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 10 MG/ML ORAL CONC [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN 100 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 100 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN 25 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 25 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN 5% CREAM (G) [Zonalon] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 5% CREAM (G) [Zonalon].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DOXEPIN 50 MG CAPSULE [Sinequan] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 50 MG CAPSULE [Sinequan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN 75MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN 75MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN HCL 3 MG TABLET [Silenor] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN HCL 3 MG TABLET [Silenor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXEPIN HCL 6 MG TABLET [Silenor] ![Compare how all Medicare Part D PDP plans in WI cover DOXEPIN HCL 6 MG TABLET [Silenor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Doxepin Hydrochloride 150mg/1 100 CAPSULE BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in WI cover DOXERCALCIFEROL 0.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in WI cover DOXERCALCIFEROL 1 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol] ![Compare how all Medicare Part D PDP plans in WI cover DOXERCALCIFEROL 2.5 MCG CAPSULE [Hectorol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXY 100 VIAL ![Compare how all Medicare Part D PDP plans in WI cover DOXY 100 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
doxycycline 25 mg/5 ml susp ![Compare how all Medicare Part D PDP plans in WI cover doxycycline 25 mg/5 ml susp.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin] ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE HYCLATE 100 MG CAPSULE [Vibramycin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs] ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE HYCLATE 100 MG TABLET [Vibra-Tabs].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE HYCLATE 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE HYCLATE 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE HYCLATE 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE MONO 100 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 100 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE MONO 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE MONO 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE MONO 50 MG CAPSULE [Monodox] ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 50 MG CAPSULE [Monodox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DOXYCYCLINE MONO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DOXYCYCLINE MONO 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DOXYCYCLINE MONO 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DRONABINOL 10 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in WI cover DRONABINOL 10 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DRONABINOL 2.5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in WI cover DRONABINOL 2.5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DRONABINOL 5 MG CAPSULE [Marinol] ![Compare how all Medicare Part D PDP plans in WI cover DRONABINOL 5 MG CAPSULE [Marinol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
DROSPIRENONE-EE 3-0.02 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DROSPIRENONE-EE 3-0.02 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine] ![Compare how all Medicare Part D PDP plans in WI cover DROSPIRENONE-EE 3-0.03 MG TABLET [Zumandimine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DROXIA 200MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DROXIA 200MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DROXIA 300MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DROXIA 300MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DROXIA 400MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover DROXIA 400MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DROXIDOPA 100 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in WI cover DROXIDOPA 100 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DROXIDOPA 200 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in WI cover DROXIDOPA 200 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:180 /30Days |
DROXIDOPA 300 MG CAPSULE [NORTHERA] ![Compare how all Medicare Part D PDP plans in WI cover DROXIDOPA 300 MG CAPSULE [NORTHERA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:180 /30Days |
DUAVEE 0.45-20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover DUAVEE 0.45-20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | None |
DULERA 100 MCG-5 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover DULERA 100 MCG-5 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
DULERA 200 MCG-5 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover DULERA 200 MCG-5 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
DULERA 50 MCG-5 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover DULERA 50 MCG-5 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta] ![Compare how all Medicare Part D PDP plans in WI cover DULOXETINE HCL DR 20 MG CAPSULE [Cymbalta].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in WI cover DULOXETINE HCL DR 30 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DULOXETINE HCL DR 40 MG CAPSULE [Irenka] ![Compare how all Medicare Part D PDP plans in WI cover DULOXETINE HCL DR 40 MG CAPSULE [Irenka].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma] ![Compare how all Medicare Part D PDP plans in WI cover DULOXETINE HCL DR 60 MG CAPSULE DR [Drizalma].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DUPIXENT 100 MG/0.67 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover DUPIXENT 100 MG/0.67 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:1.34 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
DUPIXENT 200 MG/1.14 ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover DUPIXENT 200 MG/1.14 ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:4.56 /28Days |
DUPIXENT 200 MG/1.14 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover DUPIXENT 200 MG/1.14 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:4.56 /28Days |
DUPIXENT 300 MG/2 ML PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover DUPIXENT 300 MG/2 ML PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:8 /28Days |
DUPIXENT 300 MG/2 ML SAFE SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover DUPIXENT 300 MG/2 ML SAFE SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
25% | N/A | P Q:8 /28Days |
DUTASTERIDE 0.5 MG CAPSULE [Avodart] ![Compare how all Medicare Part D PDP plans in WI cover DUTASTERIDE 0.5 MG CAPSULE [Avodart].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn] ![Compare how all Medicare Part D PDP plans in WI cover DUTASTERIDE-TAMSULOSIN 0.5-0.4 CPMP 24HR [Jalyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | $0.00 | None |
DYANAVEL XR 10 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover DYANAVEL XR 10 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DYANAVEL XR 15 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover DYANAVEL XR 15 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DYANAVEL XR 2.5 MG/ML SUSP BP 24H ![Compare how all Medicare Part D PDP plans in WI cover DYANAVEL XR 2.5 MG/ML SUSP BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DYANAVEL XR 20 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover DYANAVEL XR 20 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
DYANAVEL XR 5 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover DYANAVEL XR 5 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |