2024 Medicare Part D Plan Formulary Information |
Network Health Select (PPO) (H5215-008-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Network Health Select (PPO). 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 Select (PPO) (H5215-008-0) Formulary Drugs Starting with the Letter I in Sheboygan County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter I
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
IBANDRONATE SODIUM 150 MG TABLET [Boniva] ![Compare how all Medicare Part D PDP plans in WI cover IBANDRONATE SODIUM 150 MG TABLET [Boniva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:1 /30Days |
IBRANCE 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBRANCE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBRANCE 125 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 125 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBRANCE 125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBRANCE 75 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 75 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBRANCE 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IBRANCE 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:21 /28Days |
IBU 600 MG TABLET [Toxicology Saliva Collection] ![Compare how all Medicare Part D PDP plans in WI cover IBU 600 MG TABLET [Toxicology Saliva Collection].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
IBU 800 MG TABLET [Samson-8] ![Compare how all Medicare Part D PDP plans in WI cover IBU 800 MG TABLET [Samson-8].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [PediaCare Children's Pain Reliever/Fever Reducer IB] ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 100 MG/5 ML ORAL SUSPENSION [PediaCare Children's Pain Reliever/Fever Reducer IB].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IBUPROFEN 400 MG TABLET [Motrin] ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 400 MG TABLET [Motrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
IBUPROFEN 600 MG TABLET [Toxicology Saliva Collection] ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 600 MG TABLET [Toxicology Saliva Collection].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
IBUPROFEN 800 MG TABLET [Samson-8] ![Compare how all Medicare Part D PDP plans in WI cover IBUPROFEN 800 MG TABLET [Samson-8].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ICATIBANT 30 MG/3 ML SYRINGE [FIRAZYR] ![Compare how all Medicare Part D PDP plans in WI cover ICATIBANT 30 MG/3 ML SYRINGE [FIRAZYR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:27 /30Days |
ICLUSIG 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
ICLUSIG 15 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 15 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
ICLUSIG 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
ICLUSIG 45 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ICLUSIG 45 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
ICOSAPENT ETHYL 1 GRAM CAPSULE [VASCEPA] ![Compare how all Medicare Part D PDP plans in WI cover ICOSAPENT ETHYL 1 GRAM CAPSULE [VASCEPA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ICOSAPENT ETHYL 500 MG CAPSULE [VASCEPA] ![Compare how all Medicare Part D PDP plans in WI cover ICOSAPENT ETHYL 500 MG CAPSULE [VASCEPA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IDHIFA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IDHIFA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IDHIFA 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IDHIFA 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
ILEVRO 0.3% OPHTH DROPS EYE DROPPER ![Compare how all Medicare Part D PDP plans in WI cover ILEVRO 0.3% OPHTH DROPS EYE DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ILUMYA 100 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ILUMYA 100 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:2 /28Days |
IMATINIB MESYLATE 100 MG TABLET [Gleevec] ![Compare how all Medicare Part D PDP plans in WI cover IMATINIB MESYLATE 100 MG TABLET [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:90 /30Days |
IMATINIB MESYLATE 400 MG TABLET [Gleevec] ![Compare how all Medicare Part D PDP plans in WI cover IMATINIB MESYLATE 400 MG TABLET [Gleevec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:90 /30Days |
IMBRUVICA 140 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 140 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:120 /30Days |
IMBRUVICA 280 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 280 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:60 /30Days |
IMBRUVICA 420 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 420 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
IMBRUVICA 70 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 70 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:240 /30Days |
IMBRUVICA 70 MG/ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover IMBRUVICA 70 MG/ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:324 /30Days |
IMIPRAMINE HCL 10 MG TABLET [Tofranil] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 10 MG TABLET [Tofranil].](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 |
IMIPRAMINE HCL 25 MG TABLET [Tofranil] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 25 MG TABLET [Tofranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IMIPRAMINE HCL 50 MG TABLET [Tofranil] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE HCL 50 MG TABLET [Tofranil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IMIPRAMINE PAMOATE 100 MG CAPSULE [Tofranil-PM] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 100 MG CAPSULE [Tofranil-PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMIPRAMINE PAMOATE 125 MG CAPSULE [Tofranil-PM] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 125 MG CAPSULE [Tofranil-PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMIPRAMINE PAMOATE 150 MG CAPSULE [Tofranil-PM] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 150 MG CAPSULE [Tofranil-PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMIPRAMINE PAMOATE 75 MG CAPSULE [Tofranil-PM] ![Compare how all Medicare Part D PDP plans in WI cover IMIPRAMINE PAMOATE 75 MG CAPSULE [Tofranil-PM].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMIQUIMOD 5% CREAM PACKET ![Compare how all Medicare Part D PDP plans in WI cover IMIQUIMOD 5% CREAM PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IMOVAX RABIES VACCINE VIAL ![Compare how all Medicare Part D PDP plans in WI cover IMOVAX RABIES VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IMPAVIDO 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover IMPAVIDO 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P |
IMVEXXY 10 MCG MAINTENANCE PAK INSERT ![Compare how all Medicare Part D PDP plans in WI cover IMVEXXY 10 MCG MAINTENANCE PAK INSERT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMVEXXY 10 MCG STARTER PACK INSR DS PK ![Compare how all Medicare Part D PDP plans in WI cover IMVEXXY 10 MCG STARTER PACK INSR DS PK.](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 |
IMVEXXY 4 MCG MAINTENANCE PACK INSERT ![Compare how all Medicare Part D PDP plans in WI cover IMVEXXY 4 MCG MAINTENANCE PACK INSERT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IMVEXXY 4 MCG STARTER PACK INSR DS PK ![Compare how all Medicare Part D PDP plans in WI cover IMVEXXY 4 MCG STARTER PACK INSR DS PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
INCASSIA 0.35 MG TABLET [Sharobel 28-Day] ![Compare how all Medicare Part D PDP plans in WI cover INCASSIA 0.35 MG TABLET [Sharobel 28-Day].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE ![Compare how all Medicare Part D PDP plans in WI cover Increlex 40mg/4mL 1 VIAL, MULTI-DOSE per CARTON / 4 mL in 1 VIAL, MULTI-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INCRUSE ELLIPTA 62.5 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover INCRUSE ELLIPTA 62.5 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
INDAPAMIDE 1.25 MG TABLET [Lozol] ![Compare how all Medicare Part D PDP plans in WI cover INDAPAMIDE 1.25 MG TABLET [Lozol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
INDAPAMIDE 2.5 MG TABLET [Lozol] ![Compare how all Medicare Part D PDP plans in WI cover INDAPAMIDE 2.5 MG TABLET [Lozol].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
INDOMETHACIN 25 MG CAPSULE [Indocin] ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 25 MG CAPSULE [Indocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
INDOMETHACIN 50 MG CAPSULE [Indocin] ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN 50 MG CAPSULE [Indocin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
INDOMETHACIN ER 75 MG CAPSULE ER [Indocin SR] ![Compare how all Medicare Part D PDP plans in WI cover INDOMETHACIN ER 75 MG CAPSULE ER [Indocin SR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
INFANRIX DTAP SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover INFANRIX DTAP SYRINGE.](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 |
INGREZZA 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
INGREZZA 60 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA 60 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
INGREZZA 80 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA 80 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:30 /30Days |
INGREZZA INITIATION PACK CAPSULE DS PK ![Compare how all Medicare Part D PDP plans in WI cover INGREZZA INITIATION PACK CAPSULE DS PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:28 /28Days |
INLYTA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:120 /30Days |
INLYTA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INLYTA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:120 /30Days |
INQOVI 35 MG-100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INQOVI 35 MG-100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:5 /28Days |
INREBIC 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover INREBIC 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P |
INSULIN ASPART 100 UNIT/ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in WI cover INSULIN ASPART 100 UNIT/ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
INSULIN ASPART 100 UNIT/ML INSULIN PEN [NovoLog PenFill] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN ASPART 100 UNIT/ML INSULIN PEN [NovoLog PenFill].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
INSULIN ASPART 100 UNIT/ML VIAL [NovoLog PenFill] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN ASPART 100 UNIT/ML VIAL [NovoLog PenFill].](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 |
INSULIN ASPART PROT-INSULN ASP INSULIN PEN [NovoLog Mix 70/30] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN ASPART PROT-INSULN ASP INSULIN PEN [NovoLog Mix 70/30].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
INSULIN ASPART PROT-INSULN ASP VIAL [NovoLog Mix 70/30] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN ASPART PROT-INSULN ASP VIAL [NovoLog Mix 70/30].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
INSULIN DEGLUDEC 100 UNIT/ML VIAL [Tresiba] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN DEGLUDEC 100 UNIT/ML VIAL [Tresiba].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN DEGLUDEC PEN (U-100) INSULN PEN [Tresiba] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN DEGLUDEC PEN (U-100) INSULN PEN [Tresiba].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN DEGLUDEC PEN (U-200) INSULN PEN [Tresiba] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN DEGLUDEC PEN (U-200) INSULN PEN [Tresiba].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE 100 UNIT/ML VIAL [Semglee] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE 100 UNIT/ML VIAL [Semglee].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE MAX SOLO U300 INSULN PEN [Toujeo SoloStar] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE MAX SOLO U300 INSULN PEN [Toujeo SoloStar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE SOLOSTAR U100 INSULN PEN [Semglee] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE SOLOSTAR U100 INSULN PEN [Semglee].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE SOLOSTAR U300 INSULN PEN [Toujeo SoloStar] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE SOLOSTAR U300 INSULN PEN [Toujeo SoloStar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE-YFGN U100 INSULIN PEN [Semglee] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE-YFGN U100 INSULIN PEN [Semglee].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN GLARGINE-YFGN U100 VIAL [Semglee] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN GLARGINE-YFGN U100 VIAL [Semglee].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INSULIN LISPRO 100 UNIT/ML INSULN PEN [LYUMJEV] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN LISPRO 100 UNIT/ML INSULN PEN [LYUMJEV].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN LISPRO 100 UNIT/ML VIAL [LYUMJEV] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN LISPRO 100 UNIT/ML VIAL [LYUMJEV].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN LISPRO JR 100 UNIT/ML INSULN PEN HF ![Compare how all Medicare Part D PDP plans in WI cover INSULIN LISPRO JR 100 UNIT/ML INSULN PEN HF.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INSULIN LISPRO MIX 75-25 KWIKPEN INSULN PEN [Humalog KwikPen Mix 75/25] ![Compare how all Medicare Part D PDP plans in WI cover INSULIN LISPRO MIX 75-25 KWIKPEN INSULN PEN [Humalog KwikPen Mix 75/25].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INTELENCE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INTELENCE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
INTRALIPID 20% IV FAT EMULSION ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 20% IV FAT EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INTRALIPID 30% IV FAT EMULSION ![Compare how all Medicare Part D PDP plans in WI cover INTRALIPID 30% IV FAT EMULSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INTRAROSA 6.5 MG VAG INSERT ![Compare how all Medicare Part D PDP plans in WI cover INTRAROSA 6.5 MG VAG INSERT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
INVEGA HAFYERA 1,092 MG/3.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover INVEGA HAFYERA 1,092 MG/3.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVEGA HAFYERA 1,560 MG/5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover INVEGA HAFYERA 1,560 MG/5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
Invega Sustenna 117 mg/0.75mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 117 mg/0.75mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Invega Sustenna 156 mg/mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 156 mg/mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
Invega Sustenna 234 mg/1.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 234 mg/1.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
Invega Sustenna 39 mg/0.25mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 39 mg/0.25mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Invega Sustenna 78 mg/0.5mL Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover Invega Sustenna 78 mg/0.5mL Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVEGA TRINZA 273 MG/0.875 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 273 MG/0.875 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVEGA TRINZA 410 MG/1.315 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 410 MG/1.315 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVEGA TRINZA 546 MG/1.75 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 546 MG/1.75 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVEGA TRINZA 819 MG/2.625 ML ![Compare how all Medicare Part D PDP plans in WI cover INVEGA TRINZA 819 MG/2.625 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
INVELTYS 1% EYE DROP EYE DROPPER ![Compare how all Medicare Part D PDP plans in WI cover INVELTYS 1% EYE DROP EYE DROPPER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
INVOKAMET 150-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 150-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
INVOKAMET 150-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 150-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
INVOKAMET 50-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 50-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
INVOKAMET 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:120 /30Days |
INVOKAMET XR 150-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET XR 150-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 150-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET XR 150-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 50-1,000 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET XR 50-1,000 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
INVOKAMET XR 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKAMET XR 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:120 /30Days |
INVOKANA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKANA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:90 /30Days |
INVOKANA 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover INVOKANA 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
IOPIDINE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover IOPIDINE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
IPOL VIAL 40;8;32; UNT ![Compare how all Medicare Part D PDP plans in WI cover IPOL VIAL 40;8;32; UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IPRAT-ALBUT 0.5-3(2.5) MG/3 ML AMPUL-NEB [DuoNeb] ![Compare how all Medicare Part D PDP plans in WI cover IPRAT-ALBUT 0.5-3(2.5) MG/3 ML AMPUL-NEB [DuoNeb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IPRATROPIUM 0.03% SPRAY [Atrovent] ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM 0.03% SPRAY [Atrovent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
IPRATROPIUM 0.06% SPRAY [Atrovent] ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM 0.06% SPRAY [Atrovent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:45 /30Days |
IPRATROPIUM BR 0.02% SOLUTION [Atrovent] ![Compare how all Medicare Part D PDP plans in WI cover IPRATROPIUM BR 0.02% SOLUTION [Atrovent].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
IRBESARTAN 150 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 150 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
IRBESARTAN 300 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 300 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
IRBESARTAN 75 MG TABLET [Avapro] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN 75 MG TABLET [Avapro].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 150-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide] ![Compare how all Medicare Part D PDP plans in WI cover IRBESARTAN-HCTZ 300-12.5 MG TABLET [Avalide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ISENTRESS 100 MG POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
ISENTRESS 100 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 100 MG TABLET CHEWABLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
ISENTRESS 25 MG TABLET CHEWABLE ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 25 MG TABLET CHEWABLE.](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 |
ISENTRESS 400MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS 400MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
ISENTRESS HD 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISENTRESS HD 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | None |
ISIBLOOM 28 DAY TABLET [Solia] ![Compare how all Medicare Part D PDP plans in WI cover ISIBLOOM 28 DAY TABLET [Solia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOLYTE P IN 5% DEXTROSE INJECTION ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE P IN 5% DEXTROSE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ISOLYTE S IV SOLUTION PH7.4 ![Compare how all Medicare Part D PDP plans in WI cover ISOLYTE S IV SOLUTION PH7.4.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ISONIAZID 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISONIAZID 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISONIAZID 50MG/5ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover ISONIAZID 50MG/5ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE DINITRATE 10 MG TABLET [Wesorbide] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE 10 MG TABLET [Wesorbide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE DINITRATE 20 MG TABLET [Wesorbide] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DINITRATE 20 MG TABLET [Wesorbide].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE DN 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISOSORBIDE DN 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE DN 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE MN ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MN ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE MONONIT 10 MG TABLET [Monoket] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONIT 10 MG TABLET [Monoket].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE MONONIT 20 MG TABLET [Monoket] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONIT 20 MG TABLET [Monoket].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE MONONIT ER 120 MG TABLET 24H [Imdur] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONIT ER 120 MG TABLET 24H [Imdur].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE MONONIT ER 60 MG TABLET 24H [Isotrate ER] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE MONONIT ER 60 MG TABLET 24H [Isotrate ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISOSORBIDE-HYDRALAZINE 20-37.5 TABLET [BiDil] ![Compare how all Medicare Part D PDP plans in WI cover ISOSORBIDE-HYDRALAZINE 20-37.5 TABLET [BiDil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ISOTON GENTAMICIN 80MG/100ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTON GENTAMICIN 80MG/100ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ISOTONIC GENTAMICIN 100 MG/100 ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTONIC GENTAMICIN 100 MG/100 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ISOTONIC GENTAMICIN 80 MG/50 ML ![Compare how all Medicare Part D PDP plans in WI cover ISOTONIC GENTAMICIN 80 MG/50 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ISRADIPINE 2.5 MG CAPSULE [DynaCirc] ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE 2.5 MG CAPSULE [DynaCirc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ISRADIPINE 5 MG CAPSULE [DynaCirc] ![Compare how all Medicare Part D PDP plans in WI cover ISRADIPINE 5 MG CAPSULE [DynaCirc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ISTURISA 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISTURISA 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P |
ISTURISA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ISTURISA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P |
ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox] ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 10 MG/ML SOLUTION [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ITRACONAZOLE 100 MG CAPSULE [Sporanox] ![Compare how all Medicare Part D PDP plans in WI cover ITRACONAZOLE 100 MG CAPSULE [Sporanox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
IVERMECTIN 1% CREAM (G) [Soolantra] ![Compare how all Medicare Part D PDP plans in WI cover IVERMECTIN 1% CREAM (G) [Soolantra].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
IVERMECTIN 3 MG TABLET [Stromectol, Sklice] ![Compare how all Medicare Part D PDP plans in WI cover IVERMECTIN 3 MG TABLET [Stromectol, Sklice].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
IWILFIN 192 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover IWILFIN 192 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P |
IXCHIQ Chikungunya 18 Years + Injectable 0.5mL Live SDV Ea ![Compare how all Medicare Part D PDP plans in WI cover IXCHIQ Chikungunya 18 Years + Injectable 0.5mL Live SDV Ea.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Ixekizumab 1ML 80 MG/ML Auto-Injector [Taltz] ![Compare how all Medicare Part D PDP plans in WI cover Ixekizumab 1ML 80 MG/ML Auto-Injector [Taltz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:2 /28Days |
Ixekizumab 1ML 80 MG/ML Prefilled Syringe [Taltz] ![Compare how all Medicare Part D PDP plans in WI cover Ixekizumab 1ML 80 MG/ML Prefilled Syringe [Taltz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
27% | N/A | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
IXIARO 6 UNIT(6 MCG)/0.5ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover IXIARO 6 UNIT(6 MCG)/0.5ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |