There are 18 stand-alone Medicare Part D plans in Wisconsin meeting your criteria.
Caution: The 2009 Medicare Part D plan information below is for research purposes.
Click here to see 2024 Medicare Part D plans
PROZAC WEEKLY 90MG CAPSULE (2 X 2 BLPK) (NDC: 00002300475) 2009 Medicare Prescription Drug Plan (PDP) Information Click here for the Chart Legend | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Does Plan Offer Gap Coverage | Drug Tier Information | Cost-Sharing | Drug Usage Mgmt |
|||
---|---|---|---|---|---|---|---|---|---|
Tier Nbr. |
Tier Desc. |
30-Day Prfrd. Pharm |
90-Day Order |
||||||
AARP MedicareRx Saver |
$28.70 | $295 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $76.50 | $214.50 | S Q:5 /31Days | |
Browse Plan Formulary | |||||||||
First Health Part D-Premier |
$31.10 | $0 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $52.00 | n/a | S Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Essentials |
$34.60 | $200 | No Gap Coverage | 4 | Tier 4 - Non-Preferred Brand | $71.00 | $142.00 | S Q:4 /28Days | |
Browse Plan Formulary | |||||||||
SilverScript Value |
$35.10 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $98.00 | $269.50 | None | |
Browse Plan Formulary | |||||||||
Humana PDP Enhanced S5884-014 |
$35.70 | $0 | No Gap Coverage | 3 | Non-Preferred Brand | $70.00 | $175.00 | Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Sterling Rx |
$39.10 | $295 | No Gap Coverage | 3 | Non-Preferred Brand | $57.00 | $114.00 | S Q:5 /34Days | |
Browse Plan Formulary | |||||||||
AdvantraRx Premier |
$39.30 | $0 | No Gap Coverage | 3 | Non-Preferred Generic/Non-Preferred Brand | $62.00 | $186.00 | S Q:4 /28Days | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Preferred |
$39.40 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $97.75 | $278.25 | S Q:5 /31Days | |
Browse Plan Formulary | |||||||||
UnitedHealth Rx Basic |
$41.90 | $0 | No Gap Coverage | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $98.00 | $279.00 | S Q:5 /31Days | |
Browse Plan Formulary | |||||||||
Humana PDP Standard S5884-074 |
$43.80 | $295 | No Gap Coverage | 3 | Other - Non-Preferred (Gen/Brand) | 45% | 45% | Q:4 /28Days | |
Browse Plan Formulary | |||||||||
SilverScript Plus |
$52.80 | $50 | Many Generics | 5 | Non-Preferred Brand | $95.00 | $261.00 | None | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
AdvantraRx Premier Plus |
$54.60 | $0 | Many Generics | 3 | Non-Preferred Generic/Non-Preferred Brand | $72.00 | $216.00 | S Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Aetna Medicare Rx Plus |
$61.60 | $0 | Some Generics | 4 | Tier 4 - Non-Preferred Brand | $77.00 | $154.00 | S Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Blue MedicareRx Premier |
$70.70 | $0 | Many Generics | 3 | Tier 3 Non-Preferred Brand or Generic | $75.00 | $187.50 | Q:4 /28Days | |
Browse Plan Formulary | |||||||||
SilverScript Complete |
$71.90 | $0 | Many Generics | 4 | Non-Preferred Brand | $98.00 | $270.00 | None | |
Browse Plan Formulary | |||||||||
AARP MedicareRx Enhanced |
$77.40 | $0 | Many Generics | 3 | Tier 3 - Other Non Preferred (Generic, Brand) | $95.00 | $270.00 | S Q:5 /31Days | |
Browse Plan Formulary | |||||||||
Humana PDP Complete S5884-044 |
$95.00 | $0 | Many Generics | 3 | Non-Preferred Brand | $70.00 | $175.00 | Q:4 /28Days | |
Browse Plan Formulary | |||||||||
Plan Name | Monthly Prem. |
De- duct- ible | Gap Coverage | Tier Nbr. |
Tier Desc. |
30-Day Prfd. Pharm |
90-Day Order |
Drug Usage Mgmt |
|
Aetna Medicare Rx Premier |
$102.70 | $0 | Many Generics | 4 | Tier 4 - Non-Preferred Brand | $65.00 | $130.00 | S Q:4 /28Days | |
Browse Plan Formulary |
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