2024 Medicare Part D Plan Formulary Information |
Network Health Choice (PPO) (H5215-011-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Network Health Choice (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 Choice (PPO) (H5215-011-0) Formulary Drugs Starting with the Letter O in Fond du Lac County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter O
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
OCALIVA 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OCALIVA 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OCALIVA 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OCALIVA 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OCELLA 3MG/0.03MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OCELLA 3MG/0.03MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OCTAGAM 10% VIAL ![Compare how all Medicare Part D PDP plans in WI cover OCTAGAM 10% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OCTAGAM 5% VIAL ![Compare how all Medicare Part D PDP plans in WI cover OCTAGAM 5% VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OCTREOTIDE 1,000 MCG/5 ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE 1,000 MCG/5 ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
OCTREOTIDE 1,000 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE 1,000 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACET 100 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
OCTREOTIDE ACET 50 MCG/ML VIAL [Sandostatin] ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACET 50 MCG/ML VIAL [Sandostatin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
OCTREOTIDE ACET 500 MCG/ML VL ![Compare how all Medicare Part D PDP plans in WI cover OCTREOTIDE ACET 500 MCG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT ![Compare how all Medicare Part D PDP plans in WI cover OCUTRICIN EYE OINTMENT 400UNT/3.5MG/10UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ODEFSEY TABLET ![Compare how all Medicare Part D PDP plans in WI cover ODEFSEY TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ODOMZO 200 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ODOMZO 200 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OFEV 100 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover OFEV 100 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
OFEV 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover OFEV 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
OFLOXACIN 0.3% EAR DROPS [Floxin] ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN 0.3% EAR DROPS [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OFLOXACIN 0.3% EYE DROPS [Ocuflox] ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN 0.3% EYE DROPS [Ocuflox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OFLOXACIN 300 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN 300 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OFLOXACIN 400 MG TABLET [Floxin] ![Compare how all Medicare Part D PDP plans in WI cover OFLOXACIN 400 MG TABLET [Floxin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OGSIVEO 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OGSIVEO 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:180 /30Days |
OJJAARA 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OJJAARA 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OJJAARA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OJJAARA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OJJAARA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OJJAARA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OLANZAPINE 10 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 10 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 10 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 10 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OLANZAPINE 15 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 15 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 2.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 2.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 20 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 20 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE 7.5 MG TABLET [Zyprexa] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE 7.5 MG TABLET [Zyprexa].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 10 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 15 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 20 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE ODT 5 MG TABLET RAPDIS [Zyprexa Zydis].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 12-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 12-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 3-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 6-25 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax] ![Compare how all Medicare Part D PDP plans in WI cover OLANZAPINE-FLUOXETINE 6-50 MG Capsule [Symbyax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN MEDOXOMIL 20 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN MEDOXOMIL 40 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN MEDOXOMIL 5 MG TABLET [Benicar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN-HCTZ 20-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN-HCTZ 40-12.5 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT] ![Compare how all Medicare Part D PDP plans in WI cover OLMESARTAN-HCTZ 40-25 MG TABLET [Benicar HCT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OLOPATADINE 665 MCG NASAL SPRY SPRAY/PUMP [Patanase] ![Compare how all Medicare Part D PDP plans in WI cover OLOPATADINE 665 MCG NASAL SPRY SPRAY/PUMP [Patanase].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30.5 /30Days |
OLUMIANT 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLUMIANT 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OLUMIANT 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLUMIANT 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OLUMIANT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OLUMIANT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza] ![Compare how all Medicare Part D PDP plans in WI cover OMEGA-3 ETHYL ESTERS 1 GM CAPSULE [Lovaza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE DR 10 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE DR 20 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec] ![Compare how all Medicare Part D PDP plans in WI cover OMEPRAZOLE DR 40 MG CAPSULE DR [Prilosec].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM ![Compare how all Medicare Part D PDP plans in WI cover OMNITROPE FOR INJECTION KIT 5.8MG 1 BOX PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG ![Compare how all Medicare Part D PDP plans in WI cover OMNITROPE INJECTION 10MG/1.5ML 10MG X 1.5ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG ![Compare how all Medicare Part D PDP plans in WI cover OMNITROPE INJECTION 5MG/1.5ML 1.5 ML CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ONDANSETRON 4 MG/5 ML SOLUTION [Zofran Solution] ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON 4 MG/5 ML SOLUTION [Zofran Solution].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ONDANSETRON HCL 4 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON HCL 4 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ONDANSETRON HCL 8 MG TABLET [Zofran] ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON HCL 8 MG TABLET [Zofran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ONDANSETRON ODT 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON ODT 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ONDANSETRON ODT 8 MG TABLET RAPDIS [Zofran ODT] ![Compare how all Medicare Part D PDP plans in WI cover ONDANSETRON ODT 8 MG TABLET RAPDIS [Zofran ODT].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ONGENTYS 25 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ONGENTYS 25 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ONGENTYS 50 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ONGENTYS 50 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ONUREG 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONUREG 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:14 /14Days |
ONUREG 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ONUREG 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:14 /14Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OPSUMIT 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OPSUMIT 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
OPVEE 2.7 MG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover OPVEE 2.7 MG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
OPZELURA 1.5% CREAM (G) ![Compare how all Medicare Part D PDP plans in WI cover OPZELURA 1.5% CREAM (G).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:240 /28Days |
ORENCIA 125 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ORENCIA 125 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:4 /28Days |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.4 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in WI cover Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.4 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:1.6 /28Days |
Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.7 mL in 1 SYRINGE, GLASS ![Compare how all Medicare Part D PDP plans in WI cover Orencia 4 SYRINGE, GLASS in 1 CARTON > 0.7 mL in 1 SYRINGE, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:2.8 /28Days |
ORENCIA CLICKJECT 125 MG/ML ![Compare how all Medicare Part D PDP plans in WI cover ORENCIA CLICKJECT 125 MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:4 /28Days |
Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover Orenitram 100 TABLET, EXTENDED RELEASE in 1 BOTTLE .](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORENITRAM ER 0.125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM ER 0.125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ORENITRAM ER 0.25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM ER 0.25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORENITRAM ER 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM ER 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORENITRAM ER 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM ER 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORENITRAM MONTH 1 TITRATION KIT ER DSPK ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM MONTH 1 TITRATION KIT ER DSPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORENITRAM MONTH 2 TITRATION KIT ER DSPK ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM MONTH 2 TITRATION KIT ER DSPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORENITRAM MONTH 3 TITRATION KIT ER DSPK ![Compare how all Medicare Part D PDP plans in WI cover ORENITRAM MONTH 3 TITRATION KIT ER DSPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORGOVYX 120 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORGOVYX 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ ![Compare how all Medicare Part D PDP plans in WI cover ORIAHNN 300-1-0.5MG/300MG CAPSULE SEQ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ORILISSA 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORILISSA 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ORILISSA 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORILISSA 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ORKAMBI 100 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORKAMBI 100 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:112 /28Days |
ORKAMBI 100-125 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in WI cover ORKAMBI 100-125 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:56 /28Days |
ORKAMBI 150-188 MG GRANULE PKT GRAN PACK ![Compare how all Medicare Part D PDP plans in WI cover ORKAMBI 150-188 MG GRANULE PKT GRAN PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:56 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ORKAMBI 200 MG-125 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORKAMBI 200 MG-125 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:112 /28Days |
ORKAMBI 75-94 MG GRANULE PACK ![Compare how all Medicare Part D PDP plans in WI cover ORKAMBI 75-94 MG GRANULE PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:56 /28Days |
ORLADEYO 110 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ORLADEYO 110 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORLADEYO 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ORLADEYO 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORPHENADRINE ER 100 MG TABLET [Norflex] ![Compare how all Medicare Part D PDP plans in WI cover ORPHENADRINE ER 100 MG TABLET [Norflex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ORSERDU 345 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORSERDU 345 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ORSERDU 86 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ORSERDU 86 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [Tamiflu] ![Compare how all Medicare Part D PDP plans in WI cover OSELTAMIVIR 6 MG/ML ORAL SUSPENSION [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in WI cover OSELTAMIVIR PHOS 30 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in WI cover OSELTAMIVIR PHOS 45 MG CAPSULE [Tamiflu].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu] ![Compare how all Medicare Part D PDP plans in WI cover OSELTAMIVIR PHOS 75 MG CAPSULE [Tamiflu].](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 |
OSMOLEX ER 129 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover OSMOLEX ER 129 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OSMOLEX ER 193 MG TABLET BP 24H ![Compare how all Medicare Part D PDP plans in WI cover OSMOLEX ER 193 MG TABLET BP 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OSPHENA 60 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OSPHENA 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
OTEZLA 28 DAY STARTER PACK TABLET DS PK ![Compare how all Medicare Part D PDP plans in WI cover OTEZLA 28 DAY STARTER PACK TABLET DS PK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:55 /28Days |
OTEZLA 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OTEZLA 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
OXACILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover OXACILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OXACILLIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover OXACILLIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OXACILLIN 1GM/50ML INJ ![Compare how all Medicare Part D PDP plans in WI cover OXACILLIN 1GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OXACILLIN 2 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover OXACILLIN 2 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OXACILLIN 2GM/50ML INJ ![Compare how all Medicare Part D PDP plans in WI cover OXACILLIN 2GM/50ML INJ.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
OXAPROZIN 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover OXAPROZIN 600 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 |
OXAZEPAM 10 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover OXAZEPAM 10 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
OXAZEPAM 15 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover OXAZEPAM 15 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
OXAZEPAM 30 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover OXAZEPAM 30 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
OXCARBAZEPINE 150 MG TABLET [Trileptal] ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 150 MG TABLET [Trileptal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXCARBAZEPINE 300 MG TABLET [Trileptal] ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 300 MG TABLET [Trileptal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXCARBAZEPINE 300 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 300 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXCARBAZEPINE 600 MG TABLET [Trileptal] ![Compare how all Medicare Part D PDP plans in WI cover OXCARBAZEPINE 600 MG TABLET [Trileptal].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXERVATE 0.002% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover OXERVATE 0.002% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:112 /365Days |
OXYBUTYNIN 5 MG TABLET [Ditropan] ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN 5 MG TABLET [Ditropan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXYBUTYNIN 5 MG/5 ML SYRUP [Ditropan] ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN 5 MG/5 ML SYRUP [Ditropan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXYBUTYNIN CL ER 10 MG TABLET 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CL ER 10 MG TABLET 24 [Ditropan XL].](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 |
OXYBUTYNIN CL ER 15 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CL ER 15 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL] ![Compare how all Medicare Part D PDP plans in WI cover OXYBUTYNIN CL ER 5 MG TABLET ER 24 [Ditropan XL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
OXYCODONE HCL (IR) 20 MG TABLET [Roxicodone] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL (IR) 20 MG TABLET [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
OXYCODONE HCL (IR) 5 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL (IR) 5 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OXYCODONE HCL 10 MG TABLET [Dazidox] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 10 MG TABLET [Dazidox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 100 MG/5 ML ORAL CONC [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
OXYCODONE HCL 15 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 15 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
OXYCODONE HCL 30 MG TABLET [Roxybond] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 30 MG TABLET [Roxybond].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
OXYCODONE HCL 5 MG CAPSULE [OxyIR] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 5 MG CAPSULE [OxyIR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OXYCODONE HCL 5 MG/5 ML SOLUTION [Roxicodone] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL 5 MG/5 ML SOLUTION [Roxicodone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:1200 /30Days |
OXYCODONE HCL ER 10 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL ER 10 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OXYCODONE HCL ER 20 MG TABLET 12H [OxyContin] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE HCL ER 20 MG TABLET 12H [OxyContin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:90 /30Days |
OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE-ACETAMINOPHEN 10-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE-ACETAMINOPHEN 5-325 TABLET [Roxicet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OXYCODONE-ACETAMINOPHN 2.5-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE-ACETAMINOPHN 2.5-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OXYCODONE-ACETAMINOPHN 7.5-325 TABLET [Percocet] ![Compare how all Medicare Part D PDP plans in WI cover OXYCODONE-ACETAMINOPHN 7.5-325 TABLET [Percocet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
OxyContin 10mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OxyContin 15mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 15mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OxyContin 20mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 20mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OxyContin 30mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 30mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OxyContin 40mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 40mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OxyContin 60mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 60mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OxyContin 80mg/1 ![Compare how all Medicare Part D PDP plans in WI cover OxyContin 80mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
OXYMORPHONE HCL 10 MG TABLET [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL 10 MG TABLET [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:360 /30Days |
OXYMORPHONE HCL 5 MG TABLET [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL 5 MG TABLET [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:180 /30Days |
OXYMORPHONE HCL ER 10 MG TABLET ER 12H ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 10 MG TABLET ER 12H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 15 MG TABLET ER 12H ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 15 MG TABLET ER 12H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 20 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 30 MG TABLET 12H [Opana ER] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 30 MG TABLET 12H [Opana ER].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 40 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana] ![Compare how all Medicare Part D PDP plans in WI cover OXYMORPHONE HCL ER 7.5 MG TABLET ER 12H [Opana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:90 /30Days |
OZEMPIC 0.25-0.5 MG/DOSE PEN PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover OZEMPIC 0.25-0.5 MG/DOSE PEN PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:3 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
OZEMPIC 1 MG/DOSE (4 MG/3 ML) PEN INJECTOR ![Compare how all Medicare Part D PDP plans in WI cover OZEMPIC 1 MG/DOSE (4 MG/3 ML) PEN INJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:3 /30Days |
OZEMPIC 2 MG/DOSE (8 MG/3 ML) PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover OZEMPIC 2 MG/DOSE (8 MG/3 ML) PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:3 /30Days |