MedicarePartD.guide

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2026 HealthSpring Assurance Rx (PDP) formulary (drug list)

Contract S5617, plan 003 · Maine · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 01 plan.

Hide drugs on tiers

75 drugs starting with H.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
HADLIMA 40 mg/.4mL SolutionAdalimumab-Bwwd5Specialty Tier25%N/A
  • PA
  • QL 2.4 per 28 days
HADLIMA 40 mg/.4mL SolutionAdalimumab-Bwwd5Specialty Tier25%N/A
  • PA
  • QL 2.4 per 28 days
HADLIMA 40 mg/.8mL SolutionAdalimumab-Bwwd5Specialty Tier25%N/A
  • PA
  • QL 4.8 per 28 days
HADLIMA 40 mg/.8mL SolutionAdalimumab-Bwwd5Specialty Tier25%N/A
  • PA
  • QL 4.8 per 28 days
HAILEY 24 FE KitNorethindrone Acetate And Ethinyl Estradiol, And Ferrous Fumarate4Non-Preferred Drug30%30%None
HAILEY FE 1/20 KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate4Non-Preferred Drug30%30%None
HALOBETASOL PROPIONATE .5 mg/g Cream4Non-Preferred Drug30%30%None
HALOBETASOL PROPIONATE .5 mg/g Ointment4Non-Preferred Drug30%30%None
HALOPERIDOL .5 mg Tablet2Generic10%10%None
HALOPERIDOL 1 mg Tablet3Preferred Brand25%25%None
HALOPERIDOL 10 mg Tablet3Preferred Brand25%25%None
HALOPERIDOL 2 mg Tablet2Generic10%10%None
HALOPERIDOL 2 mg/mL Solution2Generic10%10%None
HALOPERIDOL 20 mg Tablet2Generic10%10%None
HALOPERIDOL 5 mg Tablet3Preferred Brand25%25%None
HALOPERIDOL 5 mg/mL Injection, SolutionHaloperidol Lactate4Non-Preferred Drug30%30%None
HALOPERIDOL DECANOATE 100 mg/mL Injection4Non-Preferred Drug30%30%None
HALOPERIDOL DECANOATE 50 mg/mL Injection4Non-Preferred Drug30%30%None
HALOPERIDOL DECANOATE 50 mg/mL Injection4Non-Preferred Drug30%30%None
HALOPERIDOL DECANOATE 500 mg/5mL Injection, Solution4Non-Preferred Drug30%30%None
HARVONI 33.75/150 mg PelletLedipasvir And Sofosbuvir5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
HARVONI 45/200 mg PelletLedipasvir And Sofosbuvir5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
HARVONI 45/200 mg Tablet, Film CoatedLedipasvir And Sofosbuvir5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
HARVONI 90/400 mg Tablet, Film CoatedLedipasvir And Sofosbuvir5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
HAVRIX 1440 [iU]/mL Injection, SuspensionHepatitis A Vaccine3Preferred Brand25%25%None
HAVRIX 720 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine3Preferred Brand25%25%None
HEATHER .35 mg TabletNorethindrone4Non-Preferred Drug30%30%None
HEPARIN SODIUM 1000 [USP'U]/mL Injection, Solution3Preferred Brand25%25%None
HEPARIN SODIUM 10000 [USP'U]/mL Injection, Solution3Preferred Brand25%25%None
HEPARIN SODIUM 20000 [USP'U]/mL Injection, Solution3Preferred Brand25%25%None
HEPARIN SODIUM 5000 [USP'U]/mL Injection, Solution3Preferred Brand25%25%None
HERNEXEOS 60 mg Tablet, Film CoatedZongertinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
HIBERIX KitHaemophilus B Conjugate Vaccine (Tetanus Toxoid Conjugate)3Preferred Brand25%25%None
HUMULIN R U-500 KWIKPEN 500 [iU]/mL Injection, SolutionInsulin Human5Specialty Tier25%N/ANone
HYDRALAZINE HYDROCHLORIDE 10 mg Tablet1Preferred Generic5%5%None
HYDRALAZINE HYDROCHLORIDE 100 mg Tablet1Preferred Generic5%5%None
HYDRALAZINE HYDROCHLORIDE 25 mg Tablet1Preferred Generic5%5%None
HYDRALAZINE HYDROCHLORIDE 50 mg Tablet1Preferred Generic5%5%None
HYDROCHLOROTHIAZIDE 12.5 mg Capsule1Preferred Generic5%5%None
HYDROCHLOROTHIAZIDE 12.5 mg Tablet1Preferred Generic5%5%None
HYDROCHLOROTHIAZIDE 25 mg Tablet1Preferred Generic5%5%None
HYDROCHLOROTHIAZIDE 50 mg Tablet1Preferred Generic5%5%None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/300 mg/15mL Liquid4Non-Preferred Drug30%30%
  • QL 555 per 30 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/325 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 2.5/325 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 5/325 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg/15mL Solution4Non-Preferred Drug30%30%
  • QL 555 per 30 days
HYDROCODONE BITARTRATE AND IBUPROFEN 7.5/200 mg Tablet4Non-Preferred Drug30%30%
  • QL 5 per 30 days
HYDROCORTISONE 10 mg Tablet3Preferred Brand25%25%None
HYDROCORTISONE 10 mg/g Cream2Generic10%10%None
HYDROCORTISONE 10 mg/g Ointment2Generic10%10%None
HYDROCORTISONE 100 mg/60mL Suspension3Preferred Brand25%25%None
HYDROCORTISONE 20 mg Tablet3Preferred Brand25%25%None
HYDROCORTISONE 25 mg/g Cream2Generic10%10%None
HYDROCORTISONE 25 mg/g Ointment2Generic10%10%None
HYDROCORTISONE 25 mg/mL Lotion2Generic10%10%None
HYDROCORTISONE 5 mg Tablet3Preferred Brand25%25%None
HYDROCORTISONE AND ACETIC ACID 10.4/20.8 mg/mL Solution4Non-Preferred Drug30%30%None
HYDROMORPHONE HYDROCHLORIDE 1 mg/mL Solution4Non-Preferred Drug30%30%
  • QL 24 per 30 days
HYDROMORPHONE HYDROCHLORIDE 2 mg Tablet4Non-Preferred Drug30%30%
  • QL 18 per 30 days
HYDROMORPHONE HYDROCHLORIDE 4 mg Tablet4Non-Preferred Drug30%30%
  • QL 18 per 30 days
HYDROMORPHONE HYDROCHLORIDE 8 mg Tablet4Non-Preferred Drug30%30%
  • QL 18 per 30 days
HYDROXYCHLOROQUINE SULFATE 100 mg Tablet3Preferred Brand25%25%None
HYDROXYCHLOROQUINE SULFATE 200 mg Tablet, Film Coated3Preferred Brand25%25%None
HYDROXYCHLOROQUINE SULFATE 300 mg Tablet3Preferred Brand25%25%None
HYDROXYCHLOROQUINE SULFATE 400 mg Tablet3Preferred Brand25%25%None
HYDROXYUREA 500 mg Capsule2Generic10%10%None
HYDROXYZINE HYDROCHLORIDE 10 mg Tablet4Non-Preferred Drug30%30%
  • PA
HYDROXYZINE HYDROCHLORIDE 25 mg Tablet4Non-Preferred Drug30%30%
  • PA
HYDROXYZINE HYDROCHLORIDE 50 mg Tablet4Non-Preferred Drug30%30%
  • PA
HYDROXYZINE PAMOATE 100 mg Capsule3Preferred Brand25%25%
  • PA
HYDROXYZINE PAMOATE 25 mg Capsule3Preferred Brand25%25%
  • PA
HYDROXYZINE PAMOATE 50 mg Capsule3Preferred Brand25%25%
  • PA
HYRNUO 10 mg Tablet, Film CoatedSevabertinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days

PA = prior authorization, ST = step therapy, QL = quantity limit. Costs are the plan’s initial-coverage cost-sharing from the CMS 2026 formulary files; a drug not listed here is not on this plan’s formulary, though a formulary exception may still be possible.