2026 Prescription Blue Select (PDP) formulary (drug list)

Contract S5584, plan 001 · Michigan · 3,017 drugs on file · formulary ID 00026449. Each drug links to its cost in every CMS PDP Region 13 plan.

71 drugs starting with H.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
HAEGARDA C1 ESTERASE INHIBITOR SUBCUTANEOUS (HUMAN) KitHuman C1-Esterase Inhibitor	5Specialty Tier	25%	N/A	PA
HAEGARDA C1 ESTERASE INHIBITOR SUBCUTANEOUS (HUMAN) KitHuman C1-Esterase Inhibitor	5Specialty Tier	25%	N/A	PA
HALOBETASOL PROPIONATE .5 mg/g Cream	4Non-Preferred Drug	25%	25%	QL 15 per 90 days
HALOBETASOL PROPIONATE .5 mg/g Ointment	4Non-Preferred Drug	25%	25%	QL 15 per 90 days
HALOPERIDOL .5 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 1 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 10 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 2 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 2 mg/mL Solution	2Generic	$5.00	$15.00	None
HALOPERIDOL 20 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 5 mg Tablet	3Preferred Brand	20%	20%	None
HALOPERIDOL 5 mg/mL Injection, SolutionHaloperidol Lactate	4Non-Preferred Drug	25%	25%	None
HALOPERIDOL DECANOATE 100 mg/mL Injection	4Non-Preferred Drug	25%	25%	None
HALOPERIDOL DECANOATE 50 mg/mL Injection	4Non-Preferred Drug	25%	25%	None
HALOPERIDOL DECANOATE 50 mg/mL Injection	4Non-Preferred Drug	25%	25%	None
HALOPERIDOL DECANOATE 500 mg/5mL Injection, Solution	4Non-Preferred Drug	25%	25%	None
HAVRIX 1440 [iU]/mL Injection, SuspensionHepatitis A Vaccine	3Preferred Brand	20%	20%	None
HAVRIX 720 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine	3Preferred Brand	20%	20%	None
HEATHER .35 mg TabletNorethindrone	3Preferred Brand	20%	20%	None
HEPARIN SODIUM 1000 [USP'U]/mL Injection, Solution	3Preferred Brand	20%	20%	None
HEPARIN SODIUM 10000 [USP'U]/mL Injection, Solution	3Preferred Brand	20%	20%	None
HEPARIN SODIUM 20000 [USP'U]/mL Injection, Solution	3Preferred Brand	20%	20%	None
HEPARIN SODIUM 5000 [USP'U]/mL Injection, Solution	3Preferred Brand	20%	20%	None
HERNEXEOS 60 mg Tablet, Film CoatedZongertinib	5Specialty Tier	25%	N/A	PA
HIBERIX KitHaemophilus B Conjugate Vaccine (Tetanus Toxoid Conjugate)	3Preferred Brand	20%	20%	None
HUMALOG 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG JUNIOR KWIKPEN 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG KWIKPEN 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG KWIKPEN 200 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG MIX50/50 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG MIX75/25 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMALOG MIX75/25 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	20%	20%	None
HUMULIN 70/30 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	20%	20%	None
HUMULIN 70/30 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	20%	20%	None
HUMULIN N 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	20%	20%	None
HUMULIN N 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	20%	20%	None
HUMULIN R 100 [iU]/mL Injection, SolutionInsulin Human	3Preferred Brand	20%	20%	None
HUMULIN R U-500 KWIKPEN 500 [iU]/mL Injection, SolutionInsulin Human	5Specialty Tier	25%	N/A	PA
HYDRALAZINE HYDROCHLORIDE 10 mg Tablet	2Generic	$5.00	$15.00	None
HYDRALAZINE HYDROCHLORIDE 100 mg Tablet	2Generic	$5.00	$15.00	None
HYDRALAZINE HYDROCHLORIDE 25 mg Tablet	2Generic	$5.00	$15.00	None
HYDRALAZINE HYDROCHLORIDE 50 mg Tablet	2Generic	$5.00	$15.00	None
HYDROCHLOROTHIAZIDE 12.5 mg Capsule	1Preferred Generic	$1.00	$3.00	None
HYDROCHLOROTHIAZIDE 12.5 mg Tablet	1Preferred Generic	$1.00	$3.00	None
HYDROCHLOROTHIAZIDE 25 mg Tablet	1Preferred Generic	$1.00	$3.00	None
HYDROCHLOROTHIAZIDE 50 mg Tablet	1Preferred Generic	$1.00	$3.00	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/325 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 5/325 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
HYDROCODONE BITARTRATE AND IBUPROFEN 7.5/200 mg Tablet	3Preferred Brand	20%	20%	QL 155 per 31 days
HYDROCORTISONE 10 mg Tablet	3Preferred Brand	20%	20%	None
HYDROCORTISONE 10 mg/g Ointment	2Generic	$5.00	$15.00	QL 9 per 90 days
HYDROCORTISONE 100 mg/60mL Suspension	4Non-Preferred Drug	25%	25%	None
HYDROCORTISONE 20 mg Tablet	3Preferred Brand	20%	20%	None
HYDROCORTISONE 25 mg/g Cream	2Generic	$5.00	$15.00	QL 9 per 90 days
HYDROCORTISONE 25 mg/g Ointment	2Generic	$5.00	$15.00	QL 9 per 90 days
HYDROCORTISONE 25 mg/mL Lotion	3Preferred Brand	20%	20%	QL 354 per 90 days
HYDROCORTISONE 5 mg Tablet	3Preferred Brand	20%	20%	None
HYDROCORTISONE VALERATE 2 mg/g Cream	4Non-Preferred Drug	25%	25%	QL 18 per 90 days
HYDROMORPHONE HYDROCHLORIDE 2 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
HYDROMORPHONE HYDROCHLORIDE 4 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
HYDROMORPHONE HYDROCHLORIDE 8 mg Tablet	3Preferred Brand	20%	20%	QL 248 per 31 days
HYDROXYCHLOROQUINE SULFATE 200 mg Tablet, Film Coated	4Non-Preferred Drug	25%	25%	None
HYDROXYUREA 500 mg Capsule	2Generic	$5.00	$15.00	None
HYDROXYZINE HYDROCHLORIDE 10 mg Tablet	2Generic	$5.00	$15.00	None
HYDROXYZINE HYDROCHLORIDE 25 mg Tablet	2Generic	$5.00	$15.00	None
HYDROXYZINE HYDROCHLORIDE 50 mg Tablet	2Generic	$5.00	$15.00	None
HYDROXYZINE PAMOATE 25 mg Capsule	2Generic	$5.00	$15.00	None
HYDROXYZINE PAMOATE 50 mg Capsule	2Generic	$5.00	$15.00	None
HYRNUO 10 mg Tablet, Film CoatedSevabertinib	5Specialty Tier	25%	N/A	PA

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.