A non-government resource built from CMS public data
TRIBENZOR 40/5/12.5 mg Tablet, Film Coated
Also known as Olmesartan Medoxomil / Amlodipine Besylate / Hydrochlorothiazide. Coverage in Wisconsin (CMS PDP Region 16).
Not on any stand-alone Part D formulary in Wisconsin
None of the 10 stand-alone Part D (PDP) plans in CMS PDP Region 16 list this drug. On one of those plans the patient would pay the full retail price, or you would need a formulary exception.
Medicare Advantage plans
Medicare Advantage plans carry their own formularies, separate from stand-alone Part D, and are sold county by county. Pick a county to see every Medicare Advantage drug plan there that covers this drug.
No Medicare Advantage drug plan in WI lists it either