2024 Medicare Part D Plan Formulary Information |
Wellcare All Dual Assure (HMO D-SNP) (H8189-007-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Wellcare All Dual Assure (HMO 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 Wellcare All Dual Assure (HMO D-SNP) (H8189-007-0) Formulary Drugs Starting with the Letter D in Langlade 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 |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | S Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
DELESTROGEN INJECTION 10MG/5ML VIALMD ![Compare how all Medicare Part D PDP plans in WI cover DELESTROGEN INJECTION 10MG/5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:120 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:120 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P Q:90 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P Q:360 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:360 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:180 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:180 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P Q:120 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:120 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P Q:120 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:1200 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P Q:240 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:120 /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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:1000 /28Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:20 /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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P Q:8 /28Days |
DILANTIN 125 MG/5 ML ORAL SUSPENSION ![Compare how all Medicare Part D PDP plans in WI cover DILANTIN 125 MG/5 ML ORAL SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
DILANTIN 50MG INFATAB ![Compare how all Medicare Part D PDP plans in WI cover DILANTIN 50MG INFATAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | None |
DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT) ![Compare how all Medicare Part D PDP plans in WI cover DILANTIN EXTENDED ORAL CAPSULE 100MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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 |
Tier 1 |
15% | 15% | 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 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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 |
Tier 1 |
15% | 15% | 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 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | P |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | None |
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) |
1 |
Tier 1 |
15% | 15% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | P Q:90 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:180 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | P Q:180 /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) |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | Q:60 /30Days |
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) |
1 |
Tier 1 |
15% | 15% | P Q:1.34 /28Days |
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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | 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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
1 |
Tier 1 |
15% | 15% | Q:30 /30Days |