2024 Medicare Part D Plan Formulary Information |
Network Health PremierRx (PPO) (H5215-005-0)
Benefits & Contact Info
![Email Prescription and/or Health Benefit details for Network Health PremierRx (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 PremierRx (PPO) (H5215-005-0) Formulary Drugs Starting with the Letter A in Shawano County, WI: CMS MA Region 14 which includes: WI
|
Drugs Starting with Letter A
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
ABACAVIR 20 MG/ML SOLUTION [Ziagen] ![Compare how all Medicare Part D PDP plans in WI cover ABACAVIR 20 MG/ML SOLUTION [Ziagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ABACAVIR 300 MG TABLET [Ziagen] ![Compare how all Medicare Part D PDP plans in WI cover ABACAVIR 300 MG TABLET [Ziagen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom] ![Compare how all Medicare Part D PDP plans in WI cover ABACAVIR-LAMIVUDINE 600-300 MG TABLET [Epzicom].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ABELCET INJECTION SUSPENSION 5MG/ML ![Compare how all Medicare Part D PDP plans in WI cover ABELCET INJECTION SUSPENSION 5MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ABILIFY ASIMTUFII 720 MG/2.4ML SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY ASIMTUFII 720 MG/2.4ML SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ABILIFY ASIMTUFII 960 MG/3.2ML SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY ASIMTUFII 960 MG/3.2ML SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ABILIFY MAINTENA ER 300 MG SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY MAINTENA ER 300 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ABILIFY MAINTENA ER 300 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY MAINTENA ER 300 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ABILIFY MAINTENA ER 400 MG SUSER VIAL ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY MAINTENA ER 400 MG SUSER VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ABILIFY MAINTENA ER 400 MG SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ABILIFY MAINTENA ER 400 MG SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ABIRATERONE 500 MG TABLET [ZYTIGA] ![Compare how all Medicare Part D PDP plans in WI cover ABIRATERONE 500 MG TABLET [ZYTIGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:120 /30Days |
ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA] ![Compare how all Medicare Part D PDP plans in WI cover ABIRATERONE ACETATE 250 MG TABLET [ZYTIGA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:120 /30Days |
ABRYSVO 120 MCG / 0.5 ML INJECTION Prefilled Syringe ![Compare how all Medicare Part D PDP plans in WI cover ABRYSVO 120 MCG / 0.5 ML INJECTION Prefilled Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Acamprosate Calcium DR 333 MG tablets [Campral] ![Compare how all Medicare Part D PDP plans in WI cover Acamprosate Calcium DR 333 MG tablets [Campral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACARBOSE 100 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in WI cover ACARBOSE 100 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:90 /30Days |
ACARBOSE 25 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in WI cover ACARBOSE 25 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:360 /30Days |
ACARBOSE 50 MG TABLET [Precose] ![Compare how all Medicare Part D PDP plans in WI cover ACARBOSE 50 MG TABLET [Precose].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:180 /30Days |
ACCUTANE 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ACCUTANE 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ACCUTANE 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ACCUTANE 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ACCUTANE 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover ACCUTANE 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ACEBUTOLOL 200 MG CAPSULE [Sectral] ![Compare how all Medicare Part D PDP plans in WI cover ACEBUTOLOL 200 MG CAPSULE [Sectral].](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 |
ACEBUTOLOL 400 MG CAPSULE [Sectral] ![Compare how all Medicare Part D PDP plans in WI cover ACEBUTOLOL 400 MG CAPSULE [Sectral].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACETAMINOP-CODEINE 120-12 MG/5 SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover ACETAMINOP-CODEINE 120-12 MG/5 SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:4500 /30Days |
ACETAMINOPHEN-COD #2 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ACETAMINOPHEN-COD #2 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3] ![Compare how all Medicare Part D PDP plans in WI cover ACETAMINOPHEN-COD #3 TABLET [Tylenol with Codeine No.3].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:360 /30Days |
ACETAMINOPHEN-COD #4 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ACETAMINOPHEN-COD #4 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:180 /30Days |
ACETAMN-CAF-DIHYDRCODEIN 320.5 CAPSULE [Trezix] ![Compare how all Medicare Part D PDP plans in WI cover ACETAMN-CAF-DIHYDRCODEIN 320.5 CAPSULE [Trezix].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:300 /30Days |
ACETAZOLAMIDE 125 MG TABLET [Diamox] ![Compare how all Medicare Part D PDP plans in WI cover ACETAZOLAMIDE 125 MG TABLET [Diamox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACETAZOLAMIDE 250 MG TABLET [Diamox] ![Compare how all Medicare Part D PDP plans in WI cover ACETAZOLAMIDE 250 MG TABLET [Diamox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels] ![Compare how all Medicare Part D PDP plans in WI cover ACETAZOLAMIDE ER 500 MG CAPSULE ER [Diamox Sequels].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACETIC ACID 2% EAR SOLUTION [VoSoL] ![Compare how all Medicare Part D PDP plans in WI cover ACETIC ACID 2% EAR SOLUTION [VoSoL].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACETYLCYSTEINE 10% VIAL [Mucosil Acetylcysteine] ![Compare how all Medicare Part D PDP plans in WI cover ACETYLCYSTEINE 10% VIAL [Mucosil Acetylcysteine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine] ![Compare how all Medicare Part D PDP plans in WI cover ACETYLCYSTEINE 20% VIAL [Mucosil Acetylcysteine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ACITRETIN 10 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in WI cover ACITRETIN 10 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ACITRETIN 17.5 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in WI cover ACITRETIN 17.5 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ACITRETIN 25 MG CAPSULE [Soriatane] ![Compare how all Medicare Part D PDP plans in WI cover ACITRETIN 25 MG CAPSULE [Soriatane].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ACTEMRA 162 MG/0.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ACTEMRA 162 MG/0.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:4 /28Days |
ACTEMRA ACTPEN 162 MG/0.9 ML PEN INJCTR ![Compare how all Medicare Part D PDP plans in WI cover ACTEMRA ACTPEN 162 MG/0.9 ML PEN INJCTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:4 /28Days |
ACTHIB VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in WI cover ACTHIB VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ACTIMMUNE 100 MCG/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover ACTIMMUNE 100 MCG/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ACYCLOVIR 200 MG CAPSULE [Zovirax] ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 200 MG CAPSULE [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension] ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 200 MG/5 ML ORAL SUSPENSION [Zovirax Suspension].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ACYCLOVIR 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 400 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 |
ACYCLOVIR 5% CREAM (g) [Zovirax] ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 5% CREAM (g) [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:5 /30Days |
ACYCLOVIR 5% OINTMENT [Zovirax] ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 5% OINTMENT [Zovirax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:30 /30Days |
ACYCLOVIR 800 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ACYCLOVIR SODIUM 500 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ACYCLOVIR SODIUM 500 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ADACEL TDAP SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ADACEL TDAP SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ADACEL VIAL 2UNT/5UNT ![Compare how all Medicare Part D PDP plans in WI cover ADACEL VIAL 2UNT/5UNT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ADALIMUMAB-ADAZ(CF) 40 MG SYRINGE [Hyrimoz] ![Compare how all Medicare Part D PDP plans in WI cover ADALIMUMAB-ADAZ(CF) 40 MG SYRINGE [Hyrimoz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:2 /28Days |
ADALIMUMAB-ADAZ(CF) PEN 40 MG PEN INJCTR [Hyrimoz] ![Compare how all Medicare Part D PDP plans in WI cover ADALIMUMAB-ADAZ(CF) PEN 40 MG PEN INJCTR [Hyrimoz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:2 /28Days |
ADALIMUMAB-FKJP(CF) 20 MG SYRINGE KIT [Hulio] ![Compare how all Medicare Part D PDP plans in WI cover ADALIMUMAB-FKJP(CF) 20 MG SYRINGE KIT [Hulio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:2 /28Days |
ADALIMUMAB-FKJP(CF) 40 MG SYRINGE KIT [Idacio] ![Compare how all Medicare Part D PDP plans in WI cover ADALIMUMAB-FKJP(CF) 40 MG SYRINGE KIT [Idacio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:4 /28Days |
ADALIMUMAB-FKJP(CF) PEN 40 MG PEN INJECTOR KIT [Idacio] ![Compare how all Medicare Part D PDP plans in WI cover ADALIMUMAB-FKJP(CF) PEN 40 MG PEN INJECTOR KIT [Idacio].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:6 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADAPALENE 0.1% CREAM (G) [Differin] ![Compare how all Medicare Part D PDP plans in WI cover ADAPALENE 0.1% CREAM (G) [Differin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ADAPALENE 0.3% GEL [Differin Pump] ![Compare how all Medicare Part D PDP plans in WI cover ADAPALENE 0.3% GEL [Differin Pump].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ADBRY 150 MG/ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ADBRY 150 MG/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:6 /28Days |
ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera] ![Compare how all Medicare Part D PDP plans in WI cover ADEFOVIR DIPIVOXIL 10 MG TABLET [Hepsera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADEMPAS 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADEMPAS 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:90 /30Days |
ADEMPAS 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADEMPAS 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:90 /30Days |
ADEMPAS 1.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADEMPAS 1.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:90 /30Days |
ADEMPAS 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADEMPAS 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:90 /30Days |
ADEMPAS 2.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADEMPAS 2.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:90 /30Days |
ADLARITY 10MG/DAY WEEKLY PATCH ![Compare how all Medicare Part D PDP plans in WI cover ADLARITY 10MG/DAY WEEKLY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADLARITY 5 MG/DAY WEEKLY PATCH ![Compare how all Medicare Part D PDP plans in WI cover ADLARITY 5 MG/DAY WEEKLY PATCH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ADMELOG 100 UNIT/ML VIAL [Humalog] ![Compare how all Medicare Part D PDP plans in WI cover ADMELOG 100 UNIT/ML VIAL [Humalog].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ADMELOG SOLOSTAR 100 UNIT/ML INSULIN PEN [Humalog KwikPen] ![Compare how all Medicare Part D PDP plans in WI cover ADMELOG SOLOSTAR 100 UNIT/ML INSULIN PEN [Humalog KwikPen].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ADZENYS XR-ODT 12.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 12.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADZENYS XR-ODT 15.7 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 15.7 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADZENYS XR-ODT 18.8 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 18.8 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADZENYS XR-ODT 3.1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 3.1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADZENYS XR-ODT 6.3 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 6.3 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ADZENYS XR-ODT 9.4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ADZENYS XR-ODT 9.4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AEMCOLO DR 194 MG TABLET DR ![Compare how all Medicare Part D PDP plans in WI cover AEMCOLO DR 194 MG TABLET DR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AFREZZA 12 UNIT CARTRIDGE INHALER ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 12 UNIT CARTRIDGE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AFREZZA 4 UNIT CARTRIDGE INHALER ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 4 UNIT CARTRIDGE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AFREZZA 4 UNIT/8 UNIT/12 UNIT ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 4 UNIT/8 UNIT/12 UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AFREZZA 8 UNIT CARTRIDGE INHALER ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 8 UNIT CARTRIDGE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AFREZZA 90-4 UNIT / 90-8 UNIT ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 90-4 UNIT / 90-8 UNIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AFREZZA 90-8 UNIT / 90-12 UNIT CARTRIDGE INHALER ![Compare how all Medicare Part D PDP plans in WI cover AFREZZA 90-8 UNIT / 90-12 UNIT CARTRIDGE INHALER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AIMOVIG 140 MG/ML AUTOINJECTOR ![Compare how all Medicare Part D PDP plans in WI cover AIMOVIG 140 MG/ML AUTOINJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:1 /30Days |
AIMOVIG 70 MG/ML AUTOINJECTOR ![Compare how all Medicare Part D PDP plans in WI cover AIMOVIG 70 MG/ML AUTOINJECTOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:2 /30Days |
AJOVY 225 MG/1.5 ML AUTOINJECT ![Compare how all Medicare Part D PDP plans in WI cover AJOVY 225 MG/1.5 ML AUTOINJECT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:2 /30Days |
AJOVY 225 MG/1.5 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover AJOVY 225 MG/1.5 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:2 /30Days |
AKEEGA 100-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AKEEGA 100-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
AKEEGA 50-500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AKEEGA 50-500 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
AKLIEF 0.005% CREAM (G) ![Compare how all Medicare Part D PDP plans in WI cover AKLIEF 0.005% CREAM (G).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALBENDAZOLE 200 MG TABLET [Albenza] ![Compare how all Medicare Part D PDP plans in WI cover ALBENDAZOLE 200 MG TABLET [Albenza].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ALBUTEROL 2.5 MG/0.5 ML SOL VIAL-NEB ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL 2.5 MG/0.5 ML SOL VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:13 /30Days |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:36 /30Days |
ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA] ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL HFA 90 MCG INHALER HFA AER AD [Ventolin HFA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:17 /30Days |
ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb] ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SUL 0.63 MG/3 ML SOLUTION VIAL-NEB [Accuneb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB [Accuneb] ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SUL 1.25 MG/3 ML SOLUTION VIAL-NEB [Accuneb].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ALBUTEROL SULF 2 MG/5 ML SYRUP ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SULF 2 MG/5 ML SYRUP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALBUTEROL SULFATE 2 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SULFATE 2 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALBUTEROL SULFATE 2.5 MG/3 ML SOLUTION VIAL-NEB ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SULFATE 2.5 MG/3 ML SOLUTION VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
ALBUTEROL SULFATE 4 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALBUTEROL SULFATE 4 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate] ![Compare how all Medicare Part D PDP plans in WI cover ALCLOMETASONE DIPR 0.05% OINTMENT [Aclovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALCLOMETASONE DIPRO 0.05% CREAM (G) [Aclovate] ![Compare how all Medicare Part D PDP plans in WI cover ALCLOMETASONE DIPRO 0.05% CREAM (G) [Aclovate].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALECENSA 150 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ALECENSA 150 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:240 /30Days |
ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax] ![Compare how all Medicare Part D PDP plans in WI cover ALENDRONATE SOD 70 MG/75 ML SOLUTION [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:375 /30Days |
ALENDRONATE SODIUM 10 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in WI cover ALENDRONATE SODIUM 10 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ALENDRONATE SODIUM 35 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in WI cover ALENDRONATE SODIUM 35 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:5 /30Days |
ALENDRONATE SODIUM 70 MG TABLET [Fosamax] ![Compare how all Medicare Part D PDP plans in WI cover ALENDRONATE SODIUM 70 MG TABLET [Fosamax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:5 /30Days |
ALFUZOSIN HCL ER 10 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALFUZOSIN HCL ER 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALISKIREN 150 MG TABLET [Tekturna] ![Compare how all Medicare Part D PDP plans in WI cover ALISKIREN 150 MG TABLET [Tekturna].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ALISKIREN 300 MG TABLET [Tekturna] ![Compare how all Medicare Part D PDP plans in WI cover ALISKIREN 300 MG TABLET [Tekturna].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ALLOPURINOL 100 MG TABLET [Zyloprim] ![Compare how all Medicare Part D PDP plans in WI cover ALLOPURINOL 100 MG TABLET [Zyloprim].](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 |
ALLOPURINOL 300 MG TABLET [Zyloprim] ![Compare how all Medicare Part D PDP plans in WI cover ALLOPURINOL 300 MG TABLET [Zyloprim].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ALMOTRIPTAN MALATE 12.5 MG TABLET [Axert] ![Compare how all Medicare Part D PDP plans in WI cover ALMOTRIPTAN MALATE 12.5 MG TABLET [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:9 /30Days |
ALMOTRIPTAN MALATE 6.25 MG TABLET [Axert] ![Compare how all Medicare Part D PDP plans in WI cover ALMOTRIPTAN MALATE 6.25 MG TABLET [Axert].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:9 /30Days |
ALOGLIPTIN 12.5 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN 12.5 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOGLIPTIN 25 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN 25 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOGLIPTIN 6.25 MG TABLET [Nesina] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN 6.25 MG TABLET [Nesina].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOGLIPTIN-METFORMIN 12.5-1000 [Kazano] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-METFORMIN 12.5-1000 [Kazano].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
ALOGLIPTIN-METFORMIN 12.5-500 [Kazano] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-METFORMIN 12.5-500 [Kazano].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:60 /30Days |
ALOGLIPTIN-PIOGLIT 12.5-30 MG [Oseni] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-PIOGLIT 12.5-30 MG [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOGLIPTIN-PIOGLIT 25-15 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-PIOGLIT 25-15 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOGLIPTIN-PIOGLIT 25-30 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-PIOGLIT 25-30 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALOGLIPTIN-PIOGLIT 25-45 MG TABLET [Oseni] ![Compare how all Medicare Part D PDP plans in WI cover ALOGLIPTIN-PIOGLIT 25-45 MG TABLET [Oseni].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:30 /30Days |
ALOSETRON HCL 0.5 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in WI cover ALOSETRON HCL 0.5 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ALOSETRON HCL 1 MG TABLET [Lotronex] ![Compare how all Medicare Part D PDP plans in WI cover ALOSETRON HCL 1 MG TABLET [Lotronex].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ALPHAGAN P 0.1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover ALPHAGAN P 0.1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ALPRAZOLAM 0.25 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM 0.25 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALPRAZOLAM 0.5 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM 0.5 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALPRAZOLAM 1 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM 1 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALPRAZOLAM 2 MG TABLET [Xanax] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM 2 MG TABLET [Xanax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALPRAZOLAM ER 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM ER 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALPRAZOLAM ER 1 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM ER 1 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALPRAZOLAM ER 2 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM ER 2 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALPRAZOLAM ER 3 MG TABLET 24H [Xanax XR] ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM ER 3 MG TABLET 24H [Xanax XR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALPRAZOLAM INTENSOL 1 MG/ML ORAL CONC ![Compare how all Medicare Part D PDP plans in WI cover ALPRAZOLAM INTENSOL 1 MG/ML ORAL CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ALREX 0.2% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover ALREX 0.2% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ALTAVERA-28 TABLET [Portia] ![Compare how all Medicare Part D PDP plans in WI cover ALTAVERA-28 TABLET [Portia].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALTRENO 0.05% LOTION ![Compare how all Medicare Part D PDP plans in WI cover ALTRENO 0.05% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ALUNBRIG 180 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALUNBRIG 180 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
ALUNBRIG 30 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALUNBRIG 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:180 /30Days |
ALUNBRIG 90 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALUNBRIG 90 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
ALUNBRIG 90 MG-180 MG TABLET PACK ![Compare how all Medicare Part D PDP plans in WI cover ALUNBRIG 90 MG-180 MG TABLET PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
ALVESCO 160 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover ALVESCO 160 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:12 /30Days |
ALVESCO 80 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover ALVESCO 80 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:12 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ALYACEN 1-35-28 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALYACEN 1-35-28 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ALYQ 20 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ALYQ 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
AMABELZ 0.5 MG-0.1 MG TABLET [Mimvey Lo] ![Compare how all Medicare Part D PDP plans in WI cover AMABELZ 0.5 MG-0.1 MG TABLET [Mimvey Lo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMANTADINE 100 MG CAPSULE [Symmetrel] ![Compare how all Medicare Part D PDP plans in WI cover AMANTADINE 100 MG CAPSULE [Symmetrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMANTADINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMANTADINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMANTADINE 50 MG/5 ML SOLUTION ![Compare how all Medicare Part D PDP plans in WI cover AMANTADINE 50 MG/5 ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMBRISENTAN 10 MG TABLET [LETAIRIS] ![Compare how all Medicare Part D PDP plans in WI cover AMBRISENTAN 10 MG TABLET [LETAIRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
AMBRISENTAN 5 MG TABLET [LETAIRIS] ![Compare how all Medicare Part D PDP plans in WI cover AMBRISENTAN 5 MG TABLET [LETAIRIS].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
AMETHIA 0.15-0.03-0.01 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMETHIA 0.15-0.03-0.01 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMIKACIN SULF 500 MG/2 ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover AMIKACIN SULF 500 MG/2 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMILORIDE HCL 5 MG TABLET [Midamor] ![Compare how all Medicare Part D PDP plans in WI cover AMILORIDE HCL 5 MG TABLET [Midamor].](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 |
AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic] ![Compare how all Medicare Part D PDP plans in WI cover AMILORIDE HCL-HCTZ 5-50 MG TABLET [Moduretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10] ![Compare how all Medicare Part D PDP plans in WI cover Amino acids 4.25% in dextrose 10% Injectable Solution [Clinimix 4.25/10].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
AMIODARONE HCL 100 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in WI cover AMIODARONE HCL 100 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMIODARONE HCL 200 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in WI cover AMIODARONE HCL 200 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMIODARONE HCL 400 MG TABLET [Pacerone] ![Compare how all Medicare Part D PDP plans in WI cover AMIODARONE HCL 400 MG TABLET [Pacerone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMITRIPTYLINE HCL 10 MG TABLET [Elavil] ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 10 MG TABLET [Elavil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMITRIPTYLINE HCL 100 MG TABLET [Elavil] ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 100 MG TABLET [Elavil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMITRIPTYLINE HCL 150 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 150 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMITRIPTYLINE HCL 25 MG TABLET [Elavil] ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 25 MG TABLET [Elavil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMITRIPTYLINE HCL 50 MG TABLET [Vanatrip] ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 50 MG TABLET [Vanatrip].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMITRIPTYLINE HCL 75 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMITRIPTYLINE HCL 75 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMLODIPINE BESYLATE 10 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE BESYLATE 10 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE BESYLATE 2.5 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE BESYLATE 5 MG TABLET [Norvasc] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE BESYLATE 5 MG TABLET [Norvasc].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 10-20 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 10-40 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 2.5-10 CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 5-10 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 5-20 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-BENAZEPRIL 5-40 MG CAPSULE [Lotrel].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-OLMESARTAN 10-20 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-OLMESARTAN 10-40 MG TABLET [AZOR].](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 |
AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-OLMESARTAN 5-20 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-OLMESARTAN 5-40 MG TABLET [AZOR].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-VALSARTAN 10-160 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-VALSARTAN 10-320 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-VALSARTAN 5-160 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge] ![Compare how all Medicare Part D PDP plans in WI cover AMLODIPINE-VALSARTAN 5-320 MG TABLET [Exforge].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin] ![Compare how all Medicare Part D PDP plans in WI cover AMMONIUM LACTATE 12% CREAM (g) [Lac-Hydrin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMMONIUM LACTATE 12% LOTION ![Compare how all Medicare Part D PDP plans in WI cover AMMONIUM LACTATE 12% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMNESTEEM 10 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover AMNESTEEM 10 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMNESTEEM 20 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover AMNESTEEM 20 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMNESTEEM 40 MG CAPSULE [ZENATANE] ![Compare how all Medicare Part D PDP plans in WI cover AMNESTEEM 40 MG CAPSULE [ZENATANE].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX TR-POTASSIUM CLAVULANATE 200-28.5MG TABLET CHEWABLE [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX TR-POTASSIUM CLAVULANATE 250-125MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX TR-POTASSIUM CLAVULANATE 400-57MG TABLET CHEWABLE [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 200-28.5 MG/5 ML SUS ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 200-28.5 MG/5 ML SUS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 250-62.5 MG/5 ML ORAL SUSPENSION [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 250-62.5 MG/5 ML ORAL SUSPENSION [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 400-57 MG/5 ML ORAL SUSPENSION [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 500-125 MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 500-125 MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 600-42.9 MG/5 ML SUS ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 600-42.9 MG/5 ML SUS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOX-CLAV 875-125 MG TABLET [Augmentin] ![Compare how all Medicare Part D PDP plans in WI cover AMOX-CLAV 875-125 MG TABLET [Augmentin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXAPINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXAPINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXAPINE 150MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXAPINE 150MG 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 |
AMOXAPINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXAPINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXAPINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXAPINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 125 MG/5 ML SUSP ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 125 MG/5 ML SUSP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 125MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 125MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil] ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 200 MG/5 ML ORAL SUSPENSION [Amoxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 250 MG CHEWABLE TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 250 MG CHEWABLE TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 250 MG CAPSULE [Trimox] ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 250 MG CAPSULE [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox] ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 250 MG/5 ML ORAL SUSPENSION [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil] ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 400 MG/5 ML ORAL SUSPENSION [Amoxil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 500 MG CAPSULE [Trimox] ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 500 MG CAPSULE [Trimox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMOXICILLIN 500 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 500 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 |
AMOXICILLIN 875 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMOXICILLIN 875 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SALT COMBO 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 15MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SALT COMBO 15MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPHETAMINE SALT COMBO 7.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SALT COMBO 7.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPHETAMINE SALTS 5 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SALTS 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPHETAMINE SULFATE 10 MG TABLET [Evekeo] ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SULFATE 10 MG TABLET [Evekeo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
AMPHETAMINE SULFATE 5 MG TABLET [Evekeo] ![Compare how all Medicare Part D PDP plans in WI cover AMPHETAMINE SULFATE 5 MG TABLET [Evekeo].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
AMPHOTERICIN B 50 MG VIAL [Fungizone] ![Compare how all Medicare Part D PDP plans in WI cover AMPHOTERICIN B 50 MG VIAL [Fungizone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
AMPHOTERICIN B LIPOSOME 50 MG VIAL [AmBisome] ![Compare how all Medicare Part D PDP plans in WI cover AMPHOTERICIN B LIPOSOME 50 MG VIAL [AmBisome].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AMPICILLIN 1 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN 1 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMPICILLIN 10 GM VIAL ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN 10 GM VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AMPICILLIN 1000 MG / Sulbactam 500 MG Injection ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN 1000 MG / Sulbactam 500 MG Injection.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMPICILLIN 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN 125mg/1 10 VIAL, GLASS in 1 PACKAGE / 1 INJECTION, POWDER, FOR SOLUTION in 1 VIAL, GLASS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMPICILLIN CAPSULES 500MG 100 BOTTLE ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN CAPSULES 500MG 100 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AMPICILLIN-SULBACTAM 15 GM VIAL [Unasyn] ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN-SULBACTAM 15 GM VIAL [Unasyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AMPICILLIN-SULBACTAM 3 GM VIAL [Unasyn] ![Compare how all Medicare Part D PDP plans in WI cover AMPICILLIN-SULBACTAM 3 GM VIAL [Unasyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ANAGRELIDE HCL 0.5 MG CAPSULE [Agrylin] ![Compare how all Medicare Part D PDP plans in WI cover ANAGRELIDE HCL 0.5 MG CAPSULE [Agrylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ANAGRELIDE HCL 1 MG CAPSULE [Agrylin] ![Compare how all Medicare Part D PDP plans in WI cover ANAGRELIDE HCL 1 MG CAPSULE [Agrylin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ANASTROZOLE 1 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ANASTROZOLE 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Angeliq 0.25/0.5 28 Day Pack ![Compare how all Medicare Part D PDP plans in WI cover Angeliq 0.25/0.5 28 Day Pack.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ANGELIQ 1-0.5MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ANGELIQ 1-0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ANORO ELLIPTA 62.5-25 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover ANORO ELLIPTA 62.5-25 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ANZEMET 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ANZEMET 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P Q:8 /28Days |
APIDRA 100 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover APIDRA 100 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
APIDRA SOLOSTAR 100 UNITS/ML ![Compare how all Medicare Part D PDP plans in WI cover APIDRA SOLOSTAR 100 UNITS/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn] ![Compare how all Medicare Part D PDP plans in WI cover APOMORPHINE 30 MG/3 ML CARTRIDGE [Apokyn].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
APRACLONIDINE HCL 0.5% DROPS [Iopidine] ![Compare how all Medicare Part D PDP plans in WI cover APRACLONIDINE HCL 0.5% DROPS [Iopidine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
APREPITANT 125 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in WI cover APREPITANT 125 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:4 /28Days |
APREPITANT 125-80-80 MG PACK CAPSULE DS PK [Emend] ![Compare how all Medicare Part D PDP plans in WI cover APREPITANT 125-80-80 MG PACK CAPSULE DS PK [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:12 /28Days |
APREPITANT 40 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in WI cover APREPITANT 40 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
APREPITANT 80 MG CAPSULE [Emend] ![Compare how all Medicare Part D PDP plans in WI cover APREPITANT 80 MG CAPSULE [Emend].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:8 /28Days |
APRI 0.15-0.03 TABLET ![Compare how all Medicare Part D PDP plans in WI cover APRI 0.15-0.03 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
APTIOM 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover APTIOM 200 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 |
APTIOM 400 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover APTIOM 400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:30 /30Days |
APTIOM 600 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover APTIOM 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
APTIOM 800 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover APTIOM 800 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:60 /30Days |
APTIVUS 250MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover APTIVUS 250MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARALAST NP 1,000 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ARALAST NP 1,000 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANELLE 7-9-5 TABLET ![Compare how all Medicare Part D PDP plans in WI cover ARANELLE 7-9-5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ARANESP 10 MCG/0.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 10 MCG/0.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 100ug/0.5mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.5 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 100ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP 200MCG/0.4ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 200MCG/0.4ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP 200MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 200MCG/ML VIAL.](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 |
ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 25ug/0.42mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.42 mL in 1 SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 25ug/mL 4 VIAL, SINGLE-DOSE in 1 PACKAGE / 1 mL in 1 VIAL, SINGLE-DOSE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARANESP 500MCG/1ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 500MCG/1ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP 60MCG/ML VIAL ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 60MCG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARANESP 60ug/0.3mL 1 BLISTER PACK in 1 PACKAGE / 4 SYRINGE per BLISTER PACK / 0.3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR ![Compare how all Medicare Part D PDP plans in WI cover ARANESP PREFILLED SYRINGE SINGLE USE 150MCG 4 SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR ![Compare how all Medicare Part D PDP plans in WI cover ARANESP PREFILLED SYRINGE SINGLE USE 300MCG/0.6ML 300MCG /0.6ML SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR ![Compare how all Medicare Part D PDP plans in WI cover ARANESP PREFILLED SYRINGE SINGLE USE 40MCG 4 X 40MCG SYR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD ![Compare how all Medicare Part D PDP plans in WI cover ARANESP SINGLE USE VIAL 40MCG 4 X 40MCG/ 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARCALYST 220 MG VIAL ![Compare how all Medicare Part D PDP plans in WI cover ARCALYST 220 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AREXVY 120 MCG / 0.5 ML INJECTION SINGLE-DOSE VIAL 0.5 ML ![Compare how all Medicare Part D PDP plans in WI cover AREXVY 120 MCG / 0.5 ML INJECTION SINGLE-DOSE VIAL 0.5 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARFORMOTEROL 15 MCG/2 ML SOLUTION VIAL-NEB [Brovana] ![Compare how all Medicare Part D PDP plans in WI cover ARFORMOTEROL 15 MCG/2 ML SOLUTION VIAL-NEB [Brovana].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:120 /30Days |
ARIKAYCE 590 MG/8.4 ML VIAL-NEB ![Compare how all Medicare Part D PDP plans in WI cover ARIKAYCE 590 MG/8.4 ML VIAL-NEB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 1 MG/ML SOLUTION [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:750 /30Days |
ARIPIPRAZOLE 10 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 10 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 15 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 15 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 2 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 2 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 20 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 20 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 30 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 30 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE 5 MG TABLET [Abilify] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE 5 MG TABLET [Abilify].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:30 /30Days |
ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE ODT 10 MG TABLET RAPDIS [Abilify Discmelt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt] ![Compare how all Medicare Part D PDP plans in WI cover ARIPIPRAZOLE ODT 15 MG TABLET RAPDIS [Abilify Discmelt].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ARISTADA ER 1064 MG/3.9 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARISTADA ER 1064 MG/3.9 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARISTADA ER 441 MG/1.6 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARISTADA ER 441 MG/1.6 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARISTADA ER 662 MG/2.4 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARISTADA ER 662 MG/2.4 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARISTADA ER 882 MG/3.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARISTADA ER 882 MG/3.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE ![Compare how all Medicare Part D PDP plans in WI cover ARISTADA INITIO ER 675 MG/2.4 SUSER SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
ARMODAFINIL 150 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in WI cover ARMODAFINIL 150 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARMODAFINIL 200 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in WI cover ARMODAFINIL 200 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARMODAFINIL 250 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in WI cover ARMODAFINIL 250 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARMODAFINIL 50 MG TABLET [Nuvigil] ![Compare how all Medicare Part D PDP plans in WI cover ARMODAFINIL 50 MG TABLET [Nuvigil].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
ARNUITY ELLIPTA 100 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover ARNUITY ELLIPTA 100 MCG INH.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
ARNUITY ELLIPTA 200 MCG INH ![Compare how all Medicare Part D PDP plans in WI cover ARNUITY ELLIPTA 200 MCG INH.](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 |
ARNUITY ELLIPTA 50 MCG INH BLST W/DEV ![Compare how all Medicare Part D PDP plans in WI cover ARNUITY ELLIPTA 50 MCG INH BLST W/DEV.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:30 /30Days |
ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris] ![Compare how all Medicare Part D PDP plans in WI cover ASENAPINE 10 MG SUBLIGUAL TABLET [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris] ![Compare how all Medicare Part D PDP plans in WI cover ASENAPINE 2.5 MG TABLET SUBLIGUAL [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris] ![Compare how all Medicare Part D PDP plans in WI cover ASENAPINE 5 MG SUBLIGUAL TABLET [Saphris].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ASHLYNA 0.15-0.03-0.01 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover ASHLYNA 0.15-0.03-0.01 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ASMANEX HFA 100 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX HFA 100 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
ASMANEX HFA 200 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX HFA 200 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
ASMANEX HFA 50 MCG INHALER HFA AER AD ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX HFA 50 MCG INHALER HFA AER AD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:13 /30Days |
ASMANEX TWISTHALER 110 MCG #30 AER POW BA ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX TWISTHALER 110 MCG #30 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:1 /30Days |
ASMANEX TWISTHALER 220 MCG #120 AER POW BA ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX TWISTHALER 220 MCG #120 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:1 /30Days |
ASMANEX TWISTHALER 220 MCG #30 AER POW BA ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX TWISTHALER 220 MCG #30 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:1 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
ASMANEX TWISTHALER 220 MCG #60 AER POW BA ![Compare how all Medicare Part D PDP plans in WI cover ASMANEX TWISTHALER 220 MCG #60 AER POW BA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | Q:1 /30Days |
ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox] ![Compare how all Medicare Part D PDP plans in WI cover ASPIRIN-DIPYRIDAM ER 25-200 MG CPMP 12HR [Aggrenox].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
ASTAGRAF XL 0.5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ASTAGRAF XL 0.5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ASTAGRAF XL 1 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ASTAGRAF XL 1 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ASTAGRAF XL 5 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover ASTAGRAF XL 5 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | P |
ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in WI cover ATAZANAVIR SULFATE 150 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in WI cover ATAZANAVIR SULFATE 200 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz] ![Compare how all Medicare Part D PDP plans in WI cover ATAZANAVIR SULFATE 300 MG CAPSULE [Reyataz].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
ATENOLOL 100 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in WI cover ATENOLOL 100 MG TABLET [Tenormin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATENOLOL 25 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in WI cover ATENOLOL 25 MG TABLET [Tenormin].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATENOLOL 50 MG TABLET [Tenormin] ![Compare how all Medicare Part D PDP plans in WI cover ATENOLOL 50 MG TABLET [Tenormin].](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 |
ATENOLOL-CHLORTHALIDONE 100-25 TABLET [Tenoretic] ![Compare how all Medicare Part D PDP plans in WI cover ATENOLOL-CHLORTHALIDONE 100-25 TABLET [Tenoretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATENOLOL-CHLORTHALIDONE 50-25 TABLET [Tenoretic] ![Compare how all Medicare Part D PDP plans in WI cover ATENOLOL-CHLORTHALIDONE 50-25 TABLET [Tenoretic].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATOMOXETINE HCL 10 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 10 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 100 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 100 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 18 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 18 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 25 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 25 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 40 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 40 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 60 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 60 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOMOXETINE HCL 80 MG CAPSULE [Strattera] ![Compare how all Medicare Part D PDP plans in WI cover ATOMOXETINE HCL 80 MG CAPSULE [Strattera].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATORVASTATIN 10 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in WI cover ATORVASTATIN 10 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATORVASTATIN 20 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in WI cover ATORVASTATIN 20 MG TABLET [Lipitor].](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 |
ATORVASTATIN 40 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in WI cover ATORVASTATIN 40 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATORVASTATIN 80 MG TABLET [Lipitor] ![Compare how all Medicare Part D PDP plans in WI cover ATORVASTATIN 80 MG TABLET [Lipitor].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron] ![Compare how all Medicare Part D PDP plans in WI cover ATOVAQUONE 750 MG/5 ML ORAL SUSPENSION [Mepron].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone] ![Compare how all Medicare Part D PDP plans in WI cover Atovaquone-Proguanil 250; 100mg/1; mg/1 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATOVAQUONE-PROGUANIL 62.5-25 [Malarone] ![Compare how all Medicare Part D PDP plans in WI cover ATOVAQUONE-PROGUANIL 62.5-25 [Malarone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATROPINE 1% EYE DROPS [Isopto Atropine] ![Compare how all Medicare Part D PDP plans in WI cover ATROPINE 1% EYE DROPS [Isopto Atropine].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
ATROVENT HFA AER 17MCG ![Compare how all Medicare Part D PDP plans in WI cover ATROVENT HFA AER 17MCG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | Q:26 /30Days |
AUBRA EQ-28 TABLET [Vienva] ![Compare how all Medicare Part D PDP plans in WI cover AUBRA EQ-28 TABLET [Vienva].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AUGTYRO 40 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover AUGTYRO 40 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:240 /30Days |
AURYXIA 210 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AURYXIA 210 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO 12 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO 12 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 |
AUSTEDO 6 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO 6 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO 9 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO 9 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO XR 12 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO XR 12 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO XR 24 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO XR 24 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO XR 6 MG TABLET ER 24H ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO XR 6 MG TABLET ER 24H.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AUSTEDO XR TITRATION KT(WK1-4) TABLET 24HR DSPK ![Compare how all Medicare Part D PDP plans in WI cover AUSTEDO XR TITRATION KT(WK1-4) TABLET 24HR DSPK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P Q:42 /30Days |
AUVELITY ER 45-105 MG TABLET IR ER ![Compare how all Medicare Part D PDP plans in WI cover AUVELITY ER 45-105 MG TABLET IR ER.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | Q:60 /30Days |
AVIANE 0.1-0.02 TABLET ![Compare how all Medicare Part D PDP plans in WI cover AVIANE 0.1-0.02 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AVONEX PEN 30 MCG/0.5 ML KIT ![Compare how all Medicare Part D PDP plans in WI cover AVONEX PEN 30 MCG/0.5 ML KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
AVONEX PREFILLED SYR 30 MCG KT ![Compare how all Medicare Part D PDP plans in WI cover AVONEX PREFILLED SYR 30 MCG KT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | None |
AYVAKIT 100 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AYVAKIT 100 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 |
AYVAKIT 200 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AYVAKIT 200 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AYVAKIT 25 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AYVAKIT 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AYVAKIT 300 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AYVAKIT 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AYVAKIT 50 MG TABLET ![Compare how all Medicare Part D PDP plans in WI cover AYVAKIT 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 |
29% | N/A | P |
AZASITE 1% EYE DROPS ![Compare how all Medicare Part D PDP plans in WI cover AZASITE 1% EYE DROPS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AZATHIOPRINE 100 MG TABLET [Azasan] ![Compare how all Medicare Part D PDP plans in WI cover AZATHIOPRINE 100 MG TABLET [Azasan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
AZATHIOPRINE 50 MG TABLET [Imuran] ![Compare how all Medicare Part D PDP plans in WI cover AZATHIOPRINE 50 MG TABLET [Imuran].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | P |
AZATHIOPRINE 75 MG TABLET [Azasan] ![Compare how all Medicare Part D PDP plans in WI cover AZATHIOPRINE 75 MG TABLET [Azasan].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P |
AZELAIC ACID 15% GEL [Finacea] ![Compare how all Medicare Part D PDP plans in WI cover AZELAIC ACID 15% GEL [Finacea].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AZELASTIN-FLUTIC 137-50MCG SPRAY/PUMP [Dymista] ![Compare how all Medicare Part D PDP plans in WI cover AZELASTIN-FLUTIC 137-50MCG SPRAY/PUMP [Dymista].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | P Q:23 /30Days |
AZELASTINE 137 MCG NASAL SPRAY ![Compare how all Medicare Part D PDP plans in WI cover AZELASTINE 137 MCG NASAL SPRAY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | Q:60 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZELASTINE HCL 0.05% EYE DROPS [Optivar] ![Compare how all Medicare Part D PDP plans in WI cover AZELASTINE HCL 0.05% EYE DROPS [Optivar].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZELEX 20% CREAM (G) ![Compare how all Medicare Part D PDP plans in WI cover AZELEX 20% CREAM (G).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AZITHROMYCIN 1 GM POWDER PACKET ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 1 GM POWDER PACKET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax Powder] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 100 MG/5 ML ORAL SUSPENSION [Zithromax Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 200 MG/5 ML ORAL SUSPENSION [Zithromax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 250 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 500 MG TABLET [Zithromax Tri-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN 600 MG TABLET [Zithromax Z-Pak].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $0.00 | None |
AZITHROMYCIN I.V. 500 MG VIAL [Zithromax Powder] ![Compare how all Medicare Part D PDP plans in WI cover AZITHROMYCIN I.V. 500 MG VIAL [Zithromax Powder].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
AZSTARYS 26.1 MG-5.2 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover AZSTARYS 26.1 MG-5.2 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AZSTARYS 39.2 MG-7.8 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover AZSTARYS 39.2 MG-7.8 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AZSTARYS 52.3 MG-10.4 MG CAPSULE ![Compare how all Medicare Part D PDP plans in WI cover AZSTARYS 52.3 MG-10.4 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $237.00 | None |
AZTREONAM 2 GM VIAL [Azactam] ![Compare how all Medicare Part D PDP plans in WI cover AZTREONAM 2 GM VIAL [Azactam].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |
AZTREONAM FOR INJECTION ![Compare how all Medicare Part D PDP plans in WI cover AZTREONAM FOR INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3* |
Preferred Brand |
$42.00 | $105.00 | None |