2026 HealthSpring Assurance Rx (PDP) formulary (drug list)
Contract S5617, plan 216 · Virginia · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 07 plan.
75 drugs starting with H.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| HADLIMA 40 mg/.4mL SolutionAdalimumab-Bwwd | 5Specialty Tier | 25% | N/A |
|
| HADLIMA 40 mg/.4mL SolutionAdalimumab-Bwwd | 5Specialty Tier | 25% | N/A |
|
| HADLIMA 40 mg/.8mL SolutionAdalimumab-Bwwd | 5Specialty Tier | 25% | N/A |
|
| HADLIMA 40 mg/.8mL SolutionAdalimumab-Bwwd | 5Specialty Tier | 25% | N/A |
|
| HAILEY 24 FE KitNorethindrone Acetate And Ethinyl Estradiol, And Ferrous Fumarate | 4Non-Preferred Drug | 31% | 31% | None |
| HAILEY FE 1/20 KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate | 4Non-Preferred Drug | 31% | 31% | None |
| HALOBETASOL PROPIONATE .5 mg/g Cream | 4Non-Preferred Drug | 31% | 31% | None |
| HALOBETASOL PROPIONATE .5 mg/g Ointment | 4Non-Preferred Drug | 31% | 31% | None |
| HALOPERIDOL .5 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| HALOPERIDOL 1 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HALOPERIDOL 10 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HALOPERIDOL 2 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| HALOPERIDOL 2 mg/mL Solution | 2Generic | $2.00 | $2.00 | None |
| HALOPERIDOL 20 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| HALOPERIDOL 5 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HALOPERIDOL 5 mg/mL Injection, SolutionHaloperidol Lactate | 4Non-Preferred Drug | 31% | 31% | None |
| HALOPERIDOL DECANOATE 100 mg/mL Injection | 4Non-Preferred Drug | 31% | 31% | None |
| HALOPERIDOL DECANOATE 50 mg/mL Injection | 4Non-Preferred Drug | 31% | 31% | None |
| HALOPERIDOL DECANOATE 50 mg/mL Injection | 4Non-Preferred Drug | 31% | 31% | None |
| HALOPERIDOL DECANOATE 500 mg/5mL Injection, Solution | 4Non-Preferred Drug | 31% | 31% | None |
| HARVONI 33.75/150 mg PelletLedipasvir And Sofosbuvir | 5Specialty Tier | 25% | N/A |
|
| HARVONI 45/200 mg PelletLedipasvir And Sofosbuvir | 5Specialty Tier | 25% | N/A |
|
| HARVONI 45/200 mg Tablet, Film CoatedLedipasvir And Sofosbuvir | 5Specialty Tier | 25% | N/A |
|
| HARVONI 90/400 mg Tablet, Film CoatedLedipasvir And Sofosbuvir | 5Specialty Tier | 25% | N/A |
|
| HAVRIX 1440 [iU]/mL Injection, SuspensionHepatitis A Vaccine | 3Preferred Brand | 22% | 22% | None |
| HAVRIX 720 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine | 3Preferred Brand | 22% | 22% | None |
| HEATHER .35 mg TabletNorethindrone | 4Non-Preferred Drug | 31% | 31% | None |
| HEPARIN SODIUM 1000 [USP'U]/mL Injection, Solution | 3Preferred Brand | 22% | 22% | None |
| HEPARIN SODIUM 10000 [USP'U]/mL Injection, Solution | 3Preferred Brand | 22% | 22% | None |
| HEPARIN SODIUM 20000 [USP'U]/mL Injection, Solution | 3Preferred Brand | 22% | 22% | None |
| HEPARIN SODIUM 5000 [USP'U]/mL Injection, Solution | 3Preferred Brand | 22% | 22% | None |
| HERNEXEOS 60 mg Tablet, Film CoatedZongertinib | 5Specialty Tier | 25% | N/A |
|
| HIBERIX KitHaemophilus B Conjugate Vaccine (Tetanus Toxoid Conjugate) | 3Preferred Brand | 22% | 22% | None |
| HUMULIN R U-500 KWIKPEN 500 [iU]/mL Injection, SolutionInsulin Human | 5Specialty Tier | 25% | N/A | None |
| HYDRALAZINE HYDROCHLORIDE 10 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDRALAZINE HYDROCHLORIDE 100 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDRALAZINE HYDROCHLORIDE 25 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDRALAZINE HYDROCHLORIDE 50 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDROCHLOROTHIAZIDE 12.5 mg Capsule | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDROCHLOROTHIAZIDE 12.5 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDROCHLOROTHIAZIDE 25 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDROCHLOROTHIAZIDE 50 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/300 mg/15mL Liquid | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/325 mg Tablet | 3Preferred Brand | 22% | 22% |
|
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 2.5/325 mg Tablet | 3Preferred Brand | 22% | 22% |
|
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 5/325 mg Tablet | 3Preferred Brand | 22% | 22% |
|
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg Tablet | 3Preferred Brand | 22% | 22% |
|
| HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg/15mL Solution | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROCODONE BITARTRATE AND IBUPROFEN 7.5/200 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROCORTISONE 10 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROCORTISONE 10 mg/g Cream | 2Generic | $2.00 | $2.00 | None |
| HYDROCORTISONE 10 mg/g Ointment | 2Generic | $2.00 | $2.00 | None |
| HYDROCORTISONE 100 mg/60mL Suspension | 3Preferred Brand | 22% | 22% | None |
| HYDROCORTISONE 20 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROCORTISONE 25 mg/g Cream | 2Generic | $2.00 | $2.00 | None |
| HYDROCORTISONE 25 mg/g Ointment | 2Generic | $2.00 | $2.00 | None |
| HYDROCORTISONE 25 mg/mL Lotion | 2Generic | $2.00 | $2.00 | None |
| HYDROCORTISONE 5 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROCORTISONE AND ACETIC ACID 10.4/20.8 mg/mL Solution | 4Non-Preferred Drug | 31% | 31% | None |
| HYDROMORPHONE HYDROCHLORIDE 1 mg/mL Solution | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROMORPHONE HYDROCHLORIDE 2 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
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| HYDROMORPHONE HYDROCHLORIDE 4 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
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| HYDROMORPHONE HYDROCHLORIDE 8 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROXYCHLOROQUINE SULFATE 100 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROXYCHLOROQUINE SULFATE 200 mg Tablet, Film Coated | 3Preferred Brand | 22% | 22% | None |
| HYDROXYCHLOROQUINE SULFATE 300 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROXYCHLOROQUINE SULFATE 400 mg Tablet | 3Preferred Brand | 22% | 22% | None |
| HYDROXYUREA 500 mg Capsule | 2Generic | $2.00 | $2.00 | None |
| HYDROXYZINE HYDROCHLORIDE 10 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROXYZINE HYDROCHLORIDE 25 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROXYZINE HYDROCHLORIDE 50 mg Tablet | 4Non-Preferred Drug | 31% | 31% |
|
| HYDROXYZINE PAMOATE 100 mg Capsule | 3Preferred Brand | 22% | 22% |
|
| HYDROXYZINE PAMOATE 25 mg Capsule | 3Preferred Brand | 22% | 22% |
|
| HYDROXYZINE PAMOATE 50 mg Capsule | 3Preferred Brand | 22% | 22% |
|
| HYRNUO 10 mg Tablet, Film CoatedSevabertinib | 5Specialty Tier | 25% | N/A |
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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.