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2018 Medicare Part D Formulary Search By Drug Letter

Select a Letter below:

Drug Names Containing the Letter H in Alphabetical Order.
Example: Lipitor® is found on letter page "L" as well as letter page "A" for Atorvastatin.

Drug Name
Packaging NDC On This Nbr of 2018 Formularies
PDPs MAPDs
ACETASOL HC SOLUTION 10ML 10 ML BOT
(Hydrocortisone w/ Acetic Acid Otic)
10 ML BOT 00472088282 33
PDPs
172
MAPDs
ACTHIB VACCINE WITH DILUENT
(Haemophilus B Polysaccharide Conjugate Vaccine)
    49281054503 63
PDPs
344
MAPDs
ADALIMUMAB 50 MG/ML PREFILLED SYRINGE [HUMIRA]
(Adalimumab)
0.4 ML   00074937402 63
PDPs
344
MAPDs
ADEFOVIR DIPIVOXIL 10 MG TAB [Hepsera]
()
30 EA   42794000308 55
PDPs
342
MAPDs
Ala-cort 2.5% cream
(Hydrocortisone)
    00316012830 50
PDPs
265
MAPDs
ALA-SCALP HP 2% LOTION
(Hydrocortisone)
1 OZ BOT 00316014001 5
PDPs
27
MAPDs
ANUSOL-HC 2.5% CREAM
(Hydrocortisone)
    65649040130 5
PDPs
19
MAPDs
COLOCORT 100MG ENEMA
(Hydrocortisone)
7 X 60 ML BOTAP 00574202007 60
PDPs
293
MAPDs
CORTEF 10MG TABLET
(Hydrocortisone)
100 BOT 00009003101 6
PDPs
10
MAPDs
CORTEF 20MG TABLET
(Hydrocortisone)
100 BOT 00009004401 6
PDPs
10
MAPDs
CORTEF 5MG TABLET
(Hydrocortisone)
50 BOT 00009001201 6
PDPs
10
MAPDs
DILAUDID 2 MG TABLET
(Hydromorphone HCl)
    42858012201 4
PDPs
7
MAPDs
DILAUDID 4 MG TABLET
(Hydromorphone HCl)
    42858023450 4
PDPs
7
MAPDs
DILAUDID 5 MG/5 ML ORAL LIQUID
(Hydromorphone HCl)
    42858041616 4
PDPs
7
MAPDs
DILAUDID 8 MG TABLET
(Hydromorphone HCl)
    42858033801 4
PDPs
7
MAPDs
DOXERCALCIFEROL 0.001 MG ORAL CAPSULE [HECTOROL]
()
    58468012401 4
PDPs
13
MAPDs
Doxercalciferol 0.5 mcg capsule [HECTOROL]
()
    00054033819 30
PDPs
224
MAPDs
Doxercalciferol 1 mcg capsule [HECTOROL]
()
    00054038819 24
PDPs
224
MAPDs
Doxercalciferol 2.5 mcg capsule [HECTOROL]
()
    00054033919 24
PDPs
224
MAPDs
Doxercalciferol 4 mcg/2 ml amp [HECTOROL]
()
    00641615425 23
PDPs
213
MAPDs
DROXIA 200MG CAPSULE
(Hydroxyurea)
60 BOTPL 00003633517 51
PDPs
292
MAPDs
DROXIA 300MG CAPSULE
(Hydroxyurea)
60 BOTPL 00003633617 51
PDPs
291
MAPDs
DROXIA 400MG CAPSULE
(Hydroxyurea)
60 BOTPL 00003633717 51
PDPs
291
MAPDs
ENGERIX B INJECTION
(Hepatitis B Vaccine (Recombinant))
10 SYR CRTN 58160082052 63
PDPs
344
MAPDs
ENGERIX-B 10MCG 10 X 0.5ML VIALSD
(Hepatitis B Vaccine (Recombinant))
10 X 0.5 ML VIALSD 58160082011 63
PDPs
344
MAPDs
ENGERIX-B 20 MCG/ML SYRN
(Hepatitis B Vaccine (Recombinant))
    58160082143 63
PDPs
344
MAPDs
EXALGO 12mg/1 100 TABLET, ER in 1 BOTTLE
(HYDROMORPHONE HYDROCHLORIDE)
100 TABLET, EXTENDED RELE   23635041201 4
PDPs
7
MAPDs
EXALGO 16mg/1 100 TABLET, ER in 1 BOTTLE
(HYDROMORPHONE HYDROCHLORIDE)
100 TABLET, EXTENDED RELE   23635041601 4
PDPs
7
MAPDs
EXALGO ER 32 MG TABLET
(HYDROMORPHONE HYDROCHLORIDE)
100 EA   23635043201 4
PDPs
8
MAPDs
EXALGO 8mg/1 100 TABLET, ERE in 1 BOTTLE
(HYDROMORPHONE HYDROCHLORIDE)
100 TABLET, EXTENDED RELE   23635040801 4
PDPs
7
MAPDs
H.P. ACTHAR GEL 80 UNIT/ML VIAL
(repository corticotropin)
5 ML   63004871001 17
PDPs
131
MAPDs
Halaven 0.5mg/mL
(Eribulin)
    62856038901 43
PDPs
234
MAPDs
HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG]
(Halcinonide)
60 g in 1 TUBE   10631009630 9
PDPs
52
MAPDs
HALDOL 5MG/ML INJECTION
(Haloperidol Lactate)
1ML X 1 AMP X 10 BOX 50458025501 6
PDPs
18
MAPDs
HALDOL DECANOATE 100MG/ML INJECTION
(Haloperidol Decanoate IM)
1ML X 5 AMP BOX 50458025414 6
PDPs
18
MAPDs
HALDOL DECANOATE 50MG/ML INJECTION
(Haloperidol Decanoate IM)
1ML X 3 AMP BOX 50458025303 6
PDPs
18
MAPDs
HALOBETASOL PROP 0.05% OINTMNT
(Halobetasol Propionate)
50.000 GM   00713063986 55
PDPs
301
MAPDs
HALOBETASOL PROP 0.05% CREAM
(Halobetasol Propionate)
50.000 GM   00713064086 55
PDPs
307
MAPDs
Halog 1mg/g 60 g in 1 TUBE
(Halcinonide)
60 g in 1 TUBE   10631009430 9
PDPs
55
MAPDs
HALOPERIDOL 0.5 MG TABLET
(Haloperidol)
100.000 EA   00378035101 63
PDPs
344
MAPDs
HALOPERIDOL 1 MG TABLET
(Haloperidol)
100.000 EA   00378025701 63
PDPs
344
MAPDs
HALOPERIDOL 10 MG TABLET
(Haloperidol)
100.000 EA   68382008001 63
PDPs
344
MAPDs
HALOPERIDOL 5 MG TABLET
(Haloperidol)
100.000 EA   00378032701 63
PDPs
344
MAPDs
HALOPERIDOL DEC 100MG/ML VL
(Haloperidol Decanoate IM)
1 X 5 ML VIALMD 00703702301 63
PDPs
344
MAPDs
HALOPERIDOL DEC 50MG 10 X 1ML PKG
(Haloperidol Decanoate IM)
10 X 1 ML PKG 00703701103 63
PDPs
344
MAPDs
HALOPERIDOL LAC 2 MG/ML CONC
(Haloperidol Lactate)
120.000 ML   00121058104 63
PDPs
344
MAPDs
HALOPERIDOL LAC 5 MG/ML VIAL
(Haloperidol Lactate)
10.000 ML   63323047410 63
PDPs
344
MAPDs
HALOPERIDOL 2MG TABLET (100 CT)
(Haloperidol)
100 BOT 00378021401 63
PDPs
344
MAPDs
HALOPERIDOL 20MG TABLET (100 CT)
(Haloperidol)
100 BOT 68382008101 63
PDPs
344
MAPDs
HARVONI 90-400 MG TABLET
(Ledipasvir and Sofosbuvir)
  61958180101 46
PDPs
211
MAPDs
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD
(Hepatitis A Vaccine)
10 X 1 ML VIALSD 58160082611 63
PDPs
344
MAPDs
HAVRIX HEPATITIS A VACCINE INJECTION
(Hepatitis A Vaccine)
10 SYR CRTN 58160082552 63
PDPs
344
MAPDs
HECTOROL 0.5MCG CAPSULE
(Doxercalciferol)
    58468012001 4
PDPs
8
MAPDs
HECTOROL 2.5MCG CAPSULE
(Doxercalciferol)
    58468012101 4
PDPs
13
MAPDs
Hectorol 4ug/2mL
(Doxercalciferol)
    58468012301 4
PDPs
10
MAPDs
HEPARIN SODIUM INJECTION
(Heparin Sodium)
10 ML X 1 VIALMD X 25 TRAY 00409272002 63
PDPs
343
MAPDs
HEPARIN SODIUM INJECTION
(Heparin Sodium)
1 ML X 1 VIALSD X 25 VIAL TRAY 00409272101 63
PDPs
340
MAPDs
HEPARIN SODIUM INJECTION
(Heparin Sodium)
1 ML X 25 VIAL CRTN 25021040401 63
PDPs
337
MAPDs
Heparin Sodium in Dextrose 5; 4000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTA
(Heparin Sodium)
24 CONTAINER in 1 CASE /   00264956710 58
PDPs
291
MAPDs
HEPARIN SODIUM INJECTION
(Heparin Sodium)
10 ML X 1 VIALMD TRAY 00409272302 63
PDPs
344
MAPDs
Heparin Sodium in Dextrose 5; 10000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 250 mL in 1 CONT
(DEXTROSE (ANHYDROUS)/HEPARIN SODIUM (PORCINE))
24 CONTAINER in 1 CASE /   00264958720 45
PDPs
253
MAPDs
Heparin Sodium in Dextrose 5; 5000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTA
(DEXTROSE (ANHYDROUS)/HEPARIN SODIUM (PORCINE))
24 CONTAINER in 1 CASE /   00264957710 44
PDPs
215
MAPDs
HEPATAMINE INJECTION 8%
(Amino Acid Infusion)
6 X 500 ML BOTGL 00264937155 63
PDPs
298
MAPDs
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD
(Hepatitis B Vaccine)
1 ML VIALSD 00006499500 63
PDPs
344
MAPDs
HEPSERA 10MG TABLET
(Adefovir Dipivoxil)
    61958050101 1
PDPs
13
MAPDs
HERCEPTIN 440MG VIAL
(Trastuzumab For IV)
1 X VIAL AND DILUENT PKGCOM 50242013468 63
PDPs
343
MAPDs
HETLIOZ 20 MG CAPSULE
(tasimelteon)
    43068022001 63
PDPs
333
MAPDs
HEXALEN 50MG CAPSULES
(Altretamine)
100 BOT 62856000110 63
PDPs
344
MAPDs
HIBERIX VACCINE WITH DILUENT
(Haemophilus B Conjugate Vaccine)
    58160081811 62
PDPs
335
MAPDs
HIPREX 1 GM TABLET
(Methenamine Hippurate)
    30698027701 6
PDPs
10
MAPDs
HORIZANT ER 300 MG TABLET
(GABAPENTIN ENACARBIL)
    53451010301 3
PDPs
49
MAPDs
HORIZANT ER 600 MG TABLET
(GABAPENTIN ENACARBIL)
    53451010101 3
PDPs
47
MAPDs
HUMALOG 100 UNITS/ML VIAL
(Insulin Lispro (Human))
10.000 ML   00002751001 39
PDPs
183
MAPDs
HUMALOG 100 UNITS/ML CARTRIDGE
(Insulin Lispro (Human))
3 ML   00002751659 39
PDPs
175
MAPDs
HUMALOG KWIKPEN INJECTION
(Insulin Lispro (Human))
3 ML X 5 SYR CRTN 00002879959 39
PDPs
179
MAPDs
HUMALOG MIX 50/50 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10 ML VIAL 00002751201 37
PDPs
181
MAPDs
HUMALOG MIX 75/25 VIAL
(Insulin Lispro Prot & Lispro (Human))
1 X 10ML VIAL 00002751101 39
PDPs
183
MAPDs
HUMALOG MIX KWIKPEN INJECTION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 00002879859 37
PDPs
177
MAPDs
HUMALOG MIX KWIKPEN INJECTION SUSPENSION
(Insulin Lispro Prot & Lispro (Human))
3 ML X 5 SYR CRTN 00002879759 39
PDPs
179
MAPDs
HUMALOG 200 UNITS/ML KWIKPEN
(Insulin Lispro (Human))
    00002771227 39
PDPs
176
MAPDs
HUMATROPE 12MG CARTRIDGE
(Somatropin For)
1 PKGCOM 00002814801 5
PDPs
131
MAPDs
HUMATROPE 24MG CARTRIDGE
(Somatropin For)
1 CARTRIDGE VIAL 00002814901 5
PDPs
131
MAPDs
HUMATROPE 5 MG VIAL
(Somatropin For)
1 EA   00002733511 5
PDPs
121
MAPDs
HUMATROPE 6MG CARTRIDGE
(Somatropin For)
1 CTG 00002814701 5
PDPs
123
MAPDs
HUMIRA PEDIATRIC CROHN'S START
(ADALIMUMAB)
3 EA   00074379903 63
PDPs
332
MAPDs
HUMIRA PEDIATRIC CROHN'S START
(ADALIMUMAB)
6 EA   00074379906 63
PDPs
322
MAPDs
Humira 2 KIT per CARTON / 1 KIT in 1 KIT
(Adalimumab)
2 KIT in 1 CARTON / 1 KIT   00074379902 63
PDPs
344
MAPDs
HUMIRA 10 MG/0.2 ML SYRINGE
(Adalimumab)
2 EA   00074634702 63
PDPs
342
MAPDs
HUMIRA PEN KIT 40MG-70% 1 PKGCOM
(Adalimumab)
1 PKGCOM 00074433906 63
PDPs
343
MAPDs
HUMIRA 40 MG/0.8 ML PEN
(ADALIMUMAB)
2 EA   00074433902 63
PDPs
342
MAPDs
HUMIRA PEN PSORIASIS-UVEITIS
(Adalimumab)
    00074433907 63
PDPs
341
MAPDs
HUMULIN 70/30 VIAL
(Insulin Isophane & Regular (Human))
1 X 10 ML VIAL 00002871501 37
PDPs
179
MAPDs
HUMULIN 70/30 KWIKPEN
(Insulin Isophane & Regular (Human))
3.000 ML   00002880359 37
PDPs
180
MAPDs
HUMULIN N 100U/ML VIAL
(Insulin Isophane (Human))
10 ML VIAL 00002831501 37
PDPs
179
MAPDs
HUMULIN N 100 UNITS/ML KWIKPEN
(Insulin Isophane (Human))
3.000 ML   00002880559 37
PDPs
180
MAPDs
HUMULIN R 100U/ML VIAL
(Insulin Regular (Human))
1 X 10 ML VIAL 00002821501 37
PDPs
184
MAPDs
HUMULIN R 500 UNITS/ML KWIKPEN
(Insulin Regular (Human))
    00002882427 56
PDPs
289
MAPDs
HUMULIN R 500U/ML VIAL
(Insulin Regular (Human))
1 X 20 ML VIAL 00002850101 56
PDPs
305
MAPDs
HYCAMTIN 4 MG VIAL
(Topotecan HCl For)
    00078067461 1
PDPs
19
MAPDs
HYCET 7.5 MG-325 MG/15 ML SOLN
(Hydrocodone-Acetaminophen)
473 ML   00713070389 1
PDPs
13
MAPDs
HYDRALAZINE 10 MG TABLET
(Hydralazine HCl)
100.000 EA   50111039801 63
PDPs
344
MAPDs
HYDRALAZINE 100 MG TABLET
(Hydralazine HCl)
100.000 EA   50111039701 63
PDPs
344
MAPDs
HYDRALAZINE 20 MG/ML VIAL
(Hydralazine HCl)
1 ML   63323061401 45
PDPs
278
MAPDs
HYDRALAZINE 25 MG TABLET
(Hydralazine HCl)
100.000 EA   50111032701 63
PDPs
344
MAPDs
HYDRALAZINE 50 MG TABLET
(Hydralazine HCl)
100.000 EA   50111032801 63
PDPs
344
MAPDs
HYDREA 500MG CAPSULE
(Hydroxyurea)
100 BOT 00003083050 6
PDPs
17
MAPDs
Hydrochlorothiazide 12.5 MG Oral Capsule
(Hydrochlorothiazide)
    00378081005 63
PDPs
342
MAPDs
HYDROCHLOROTHIAZIDE 12.5 MG TB
(Hydrochlorothiazide)
100.000 EA   16729018201 63
PDPs
341
MAPDs
Hydrochlorothiazide 12.5 MG / valsartan 80 MG Oral Tablet
(Hydrochlorothiazide)
    65862054790 62
PDPs
341
MAPDs
HYDROCHLOROTHIAZIDE 25 MG TAB
(Hydrochlorothiazide)
1000.000 EA   16729018317 63
PDPs
344
MAPDs
HYDROCHLOROTHIAZIDE 50 MG TAB
(Hydrochlorothiazide)
1000.000 EA   29300012910 63
PDPs
344
MAPDs
HYDROCODON-ACETAMINOPHN 10-325
(Hydrocodone-Acetaminophen)
500.000 EA   00591261205 63
PDPs
344
MAPDs
HYDROCODON-ACETAMINOPH 2.5-325
(Hydrocodone-Acetaminophen)
100.000 EA   00591217101 24
PDPs
222
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064301 21
PDPs
180
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064801 21
PDPs
183
MAPDs
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1
(Hydrocodone-Acetaminophen)
    64376064901 21
PDPs
183
MAPDs
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL
(Hydrocodone-Acetaminophen)
    64376064016 60
PDPs
297
MAPDs
HYDROCODON-ACETAMINOPHEN 5-325
(Hydrocodone-Acetaminophen)
100.000 EA   00406012301 63
PDPs
344
MAPDs
HYDROCODON-ACETAMINOPH 7.5-325
(Hydrocodone-Acetaminophen)
100.000 EA   00406012401 63
PDPs
344
MAPDs
HYDROCODONE-IBUPROFEN 10-200
(Hydrocodone-Ibuprofen)
100.000 EA   53746011701 28
PDPs
185
MAPDs
HYDROCODONE-IBUPROFEN 5-200 MG
(Hydrocodone-Ibuprofen)
100.000 EA   53746014601 28
PDPs
199
MAPDs
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT)
(Hydrocodone-Ibuprofen)
100 BOT 53746014501 56
PDPs
320
MAPDs
HYDROCORTISONE BUTYR 0.1% OINT
(Hydrocortisone)
15.000 GM   51672408301 51
PDPs
248
MAPDs
HYDROCORTISONE 0.1% SOLN
(Hydrocortisone)
60 ML   51672406104 46
PDPs
241
MAPDs
HYDROCORTISONE 0.2% CREAM
(Hydrocortisone)
    51672129003 47
PDPs
286
MAPDs
HYDROCORTISONE VAL 0.2% OINTMT
(Hydrocortisone)
15.000 GM   51672129201 47
PDPs
281
MAPDs
HYDROCORTISONE 1% CREAM
(Hydrocortisone)
28.350 GM   00168001531 59
PDPs
320
MAPDs
HYDROCORTISONE 1% OINTMENT
(Hydrocortisone)
28.350 GM   00168002031 61
PDPs
317
MAPDs
Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort]
(Hydrocortisone)
    00316012601 45
PDPs
252
MAPDs
HYDROCORTISONE 10MG TABLET
(Hydrocortisone)
100 BOT 00603390021 63
PDPs
340
MAPDs
HYDROCORTISONE 100 MG/60 ML
(Hydrocortisone)
60.000 ML   62559013807 63
PDPs
338
MAPDs
Hydrocortisone and Acetic Acid 2.41; 3.15g/100mL; g/100mL 1 BOTTLE per CARTON / 10 mL in 1 BOTTLE
(Hydrocortisone)
1 BOTTLE in 1 CARTON / 10   45963041261 43
PDPs
252
MAPDs
HYDROCORTISONE 2.5% OINTMENT
(Hydrocortisone)
28.350 GM   00168014630 63
PDPs
344
MAPDs
HYDROCORTISONE 2.5% CREAM
(Hydrocortisone)
30.000 GM   00168008031 63
PDPs
344
MAPDs
Hydrocortisone 20mg 100 TABLET BOTTLE
(Hydrocortisone)
100 TABLET BOTTLE   00603390121 60
PDPs
340
MAPDs
HYDROCORTISONE 5MG TABLET
(Hydrocortisone)
50 BOT 00603389919 60
PDPs
336
MAPDs
Hydrocortisone butyrate 0.001 MG/MG Topical Ointment [Locoid]
(Hydrocortisone Butyrate)
    16781038945 4
PDPs
8
MAPDs
HYDROCORT BUTY 0.1% LIPO CREAM
(Hydrocortisone Butyrate)
45.000 GM   68462046447 19
PDPs
120
MAPDs
Hydrocortisone butyrate 1 MG/ML Topical Cream [Locoid]
(Hydrocortisone Butyrate)
    16781038245 6
PDPs
10
MAPDs
HYDROCORTISONE 2.5% LOTION
(Hydrocortisone)
59.000 ML   45802093716 63
PDPs
340
MAPDs
HYDROMORPHONE 1 MG/ML SOLUTION
(Hydromorphone HCl)
473 ML   00054038663 56
PDPs
276
MAPDs
HYDROMORPHONE 10 MG/ML VIAL
(Hydromorphone HCl)
1 ML   00703011003 55
PDPs
288
MAPDs
HYDROMORPHONE 10 MG/ML 5ML
(Hydromorphone HCl)
    00703011301 52
PDPs
277
MAPDs
Hydromorphone hcl er 12 mg tab
(Hydromorphone HCl)
    00591373901 10
PDPs
106
MAPDs
Hydromorphone hcl er 16 mg tab
(Hydromorphone HCl)
    00591363001 11
PDPs
110
MAPDs
Hydromorphone 2 mg/ml Syringe
(Hydromorphone HCl)
    00409131210 30
PDPs
207
MAPDs
HYDROMORPHONE 2 MG TABLET
(Hydromorphone HCl)
100.000 EA   00406324301 63
PDPs
339
MAPDs
24 HR Hydromorphone Hydrochloride 32 MG Extended Release Oral Tablet
(Hydromorphone HCl)
    13811070410 11
PDPs
107
MAPDs
HYDROMORPHONE 4 MG TABLET
(Hydromorphone HCl)
100.000 EA   00406324401 63
PDPs
339
MAPDs
Hydromorphone hcl er 8 mg tab
(Hydromorphone HCl)
    00591362901 10
PDPs
106
MAPDs
HYDROMORPHONE HCL 8MG TABLET (100 CT)
(Hydromorphone HCl)
100 BOT 00406324901 63
PDPs
339
MAPDs
HYDROXYCHLOROQUINE 200MG TABLET (500 CT)
(Hydroxychloroquine Sulfate)
500 BOT 68382009605 63
PDPs
344
MAPDs
Hydroxyprogesterone 1.25 g/5ml [MAKENA]
(Hydroxyprogesterone Caproate)
    62559054015 59
PDPs
291
MAPDs
HYDROXYUREA 500 MG CAPSULE
(Hydroxyurea)
100.000 EA   49884072401 63
PDPs
344
MAPDs
HYDROXYZINE 10 MG/5 ML SOLN
(Hydroxyzine HCl)
473 ML   60432015016 51
PDPs
279
MAPDs
HYDROXYZINE HCL 10 MG TABLET
(Hydroxyzine HCl)
100.000 EA   10702001001 58
PDPs
315
MAPDs
HYDROXYZINE 25MG/ML VIAL
(Hydroxyzine HCl)
25 X 1 ML VIALSD 00517420125 36
PDPs
230
MAPDs
HYDROXYZINE HCL 25 MG TABLET
(Hydroxyzine HCl)
500.000 EA   10702001150 58
PDPs
319
MAPDs
HYDROXYZINE HCL 50 MG TABLET
(Hydroxyzine HCl)
100.000 EA   10702001201 58
PDPs
319
MAPDs
HYDROXYZINE 50MG/ML VIAL
(Hydroxyzine HCl)
25 X 1 ML VIALSD 00517560125 34
PDPs
234
MAPDs
HYDROXYZINE PAM 100MG CAPSULE
(Hydroxyzine Pamoate)
100 BOT 00555032402 20
PDPs
186
MAPDs
HYDROXYZINE PAM 25 MG CAP
(Hydroxyzine Pamoate)
100.000 EA   00185067401 34
PDPs
255
MAPDs
HYDROXYZINE PAM 50 MG CAP
(Hydroxyzine Pamoate)
100.000 EA   00185061501 34
PDPs
253
MAPDs
HYPERRAB S-D 150 UNITS/ML VIAL
(Human Rabies Virus Immune Globulin)
    13533061802 6
PDPs
164
MAPDs
HYPERRAB S-D 150 UNITS/ML VIAL
(Human Rabies Virus Immune Globulin)
    13533061810 6
PDPs
158
MAPDs
HYSINGLA ER 100 MG TABLET
(Hydrocodone Bitartrate)
    59011027660 10
PDPs
107
MAPDs
HYSINGLA ER 120 MG TABLET
(Hydrocodone Bitartrate)
    59011027760 10
PDPs
107
MAPDs
HYSINGLA ER 20 MG TABLET
(Hydrocodone Bitartrate)
    59011027160 10
PDPs
107
MAPDs
HYSINGLA ER 30 MG TABLET
(Hydrocodone Bitartrate)
    59011027260 10
PDPs
107
MAPDs
HYSINGLA ER 40 MG TABLET
(Hydrocodone Bitartrate)
    59011027360 10
PDPs
107
MAPDs
HYSINGLA ER 60 MG TABLET
(Hydrocodone Bitartrate)
    59011027460 10
PDPs
107
MAPDs
HYSINGLA ER 80 MG TABLET
(Hydrocodone Bitartrate)
    59011027560 10
PDPs
107
MAPDs
HYZAAR 100-12.5 TABLET
(Losartan Potassium & Hydrochlorothiazide)
30.000 EA   00006074531 8
PDPs
13
MAPDs
HYZAAR 100-25 TABLET
(Losartan Potassium & Hydrochlorothiazide)
30.000 EA   00006074731 8
PDPs
13
MAPDs
HYZAAR 50-12.5 TABLET
(Losartan Potassium & Hydrochlorothiazide)
30.000 EA   00006071731 8
PDPs
13
MAPDs
IBUDONE 10; 200mg/1; mg/1 100 FILM COATED TABLETS in BOTTLE, PLASTIC
(Hydrocodone Bitartrate and Ibuprofen)
100 TABLET, FILM COATED i   50991057901 2
PDPs
13
MAPDs
LOCOID 0.1% SOLUTION
(Hydrocortisone Butyrate)
    16781039160 4
PDPs
8
MAPDs
LOCOID 0.1% LOTION
(Hydrocortisone Butyrate)
    16781039204 7
PDPs
31
MAPDs
Lorcet hd 10-325 mg tablet
(acetaminophen / hydrocodone)
    51862058701 45
PDPs
263
MAPDs
Lorcet plus 7.5-325 mg tablet
(Hydrocodone-Acetaminophen)
    51862058601 45
PDPs
258
MAPDs
lortab 10-325 mg tablet
(Hydrocodone-Acetaminophen)
    50474093201 40
PDPs
208
MAPDs
lortab 5-325 mg tablet
(Hydrocodone-Acetaminophen)
    50474093001 43
PDPs
208
MAPDs
lortab 7.5-325 mg tablet
(Hydrocodone-Acetaminophen)
    50474093101 40
PDPs
208
MAPDs
MAKENA 250 MG/ML VIAL
(Hydroxyprogesterone Caproate)
    64011024702 17
PDPs
75
MAPDs
MICORT HC 2.5% CREAM
(HYDROCORTISONE ACETATE)
28.400 GM   54766083504 4
PDPs
20
MAPDs
MICROZIDE 12.5MG CAPSULE
(Hydrochlorothiazide)
100 BOTPL 52544062201 8
PDPs
13
MAPDs
NEO/POLYMYXIN/HC EAR TUBEX 10MG/3.5MG/100UNT
(Neomycin-Polymyxin-HC)
10 ML BOT 24208063110 63
PDPs
344
MAPDs
NEOMYCIN-POLYMYXIN-HC 3.5-10K-10 SUSPENSION DROPS
(Neomycin-Polymyxin-HC)
7.5 ML BOTPL 61314064175 44
PDPs
299
MAPDs
NORCO 10-325 TABLET
(Hydrocodone-Acetaminophen)
100.000 EA   52544016101 5
PDPs
17
MAPDs
NORCO 5-325 TABLET
(Hydrocodone-Acetaminophen)
    52544007101 5
PDPs
17
MAPDs
NORCO 7.5-325 TABLET
(Hydrocodone-Acetaminophen)
    52544016201 5
PDPs
17
MAPDs
OLMESARTAN-HCTZ 20-12.5 MG TAB
(OLMESARTAN/HYDROCHLOROTHIAZIDE)
30.000 EA   00378141393 48
PDPs
250
MAPDs
OLMESARTAN-HCTZ 40-12.5 MG TAB
(OLMESARTAN/HYDROCHLOROTHIAZIDE)
30.000 EA   00378142293 48
PDPs
250
MAPDs
OLMESARTAN-HCTZ 40-25 MG TAB
(OLMESARTAN/HYDROCHLOROTHIAZIDE)
30.000 EA   00378142593 48
PDPs
250
MAPDs
PANDEL 0.1% CREAM
(Hydrocortisone Probutate)
    10337015380 6
PDPs
44
MAPDs
PEDVAXHIB VACCINE VIAL
(Haemophilus B Polysaccharide Conjugate Vaccine)
10 X .5ML SINGLE DOSE VIL BOX 00006489700 63
PDPs
344
MAPDs
PLAQUENIL 200 MG TABLET
(Hydroxychloroquine Sulfate)
    59212056210 6
PDPs
11
MAPDs
procto-pak 1% cream
(Hydrocortisone)
    64980030230 59
PDPs
311
MAPDs
PROCTOSOL-HC 2.5% CREAM
(Hydrocortisone)
1 OUNCE TUBE 10631040701 63
PDPs
333
MAPDs
proctozone-hc 2.5% cream
(Hydrocortisone)
    64980030130 63
PDPs
343
MAPDs
RECOMBIVAX HB 10 MCG/ML SYR
(Hepatitis B Vaccine (Recombinant))
    00006409402 63
PDPs
344
MAPDs
RECOMBIVAX HB 40MCG/ML VIAL
(Hepatitis B Vaccine (Recombinant))
1 ML VIALSD 00006499200 63
PDPs
344
MAPDs
RECOMBIVAX HB 5 MCG/0.5 ML SYR
(Hepatitis B Vaccine (Recombinant))
    00006409301 63
PDPs
344
MAPDs
SOLU CORTEF INJECTION 100 MG/VIAL
(Hydrocortisone Sodium Succinate For)
2 ML X 1 VIALSD 00009001103 14
PDPs
146
MAPDs
SOLU CORTEF 250MG/VIAL INJECTION
(Hydrocortisone Sodium Succinate For)
2ML X 1 VIALSD 00009001305 34
PDPs
197
MAPDs
TRIAMTERENE-HCTZ 37.5-25 MG CP
(Triamterene & Hydrochlorothiazide)
100.000 EA   00781207401 63
PDPs
344
MAPDs
TRIAMTERENE-HCTZ 37.5-25 MG TB
(Triamterene & Hydrochlorothiazide)
500.000 EA   68001021603 63
PDPs
344
MAPDs
TRIAMTERENE/HCTZ 50-25 MG CAP
(Triamterene & Hydrochlorothiazide)
100 EA   00781271501 38
PDPs
238
MAPDs
TRIAMTERENE-HCTZ 75-50 MG TAB
(Triamterene & Hydrochlorothiazide)
500.000 EA   60505265705 63
PDPs
344
MAPDs
TWINRIX TF PF VACCINE 720UNT/20ML 10 X 1ML VIALSD
(Hepatitis A (Inact)-Hep B (Recomb) Vac)
10 X 1ML VIALSD 58160081511 63
PDPs
344
MAPDs
ULTRAVATE 0.05 % 60 ML
(Halobetasol Propionate)
    10631012204 5
PDPs
22
MAPDs
Ultravate 0.5mg/g 50 g in 1 TUBE
(Halobetasol Propionate)
50 g in 1 TUBE   10631010250 6
PDPs
10
MAPDs
Ultravate 0.5mg/g 50 g in 1 TUBE
(Halobetasol Propionate)
50 g in 1 TUBE   10631010350 6
PDPs
10
MAPDs
VAQTA 25 UNITS/0.5 ML SYRINGE
(Hepatitis A Vaccine)
    00006409502 63
PDPs
344
MAPDs
VAQTA 50 UNITS/ML SYRINGE
(Hepatitis A Vaccine)
    00006409602 63
PDPs
344
MAPDs
VICODIN 5-300 MG TABLET
(Hydrocodone-Acetaminophen)
500 EA   00074304153 22
PDPs
141
MAPDs
VICODIN ES 7.5-300 MG TABLET
(Hydrocodone-Acetaminophen)
500.000 EA   00074304353 22
PDPs
142
MAPDs
VICODIN HP 10-300 MG TABLET
(Hydrocodone-Acetaminophen)
500 EA   00074305453 22
PDPs
141
MAPDs
VISTARIL 25MG CAPSULE
(Hydroxyzine Pamoate)
100 BOT 00069541066 3
PDPs
7
MAPDs
VISTARIL 50MG CAPSULE
(Hydroxyzine Pamoate)
100 BOT 00069542066 3
PDPs
7
MAPDs
XODOL 10-300MG TABLET
(Hydrocodone-Acetaminophen)
    59630091110 5
PDPs
13
MAPDs
XODOL 5-300 TABLET
(Hydrocodone-Acetaminophen)
    59630091210 1
PDPs
9
MAPDs
XODOL 7.5-300 MG TABLET
(Hydrocodone-Acetaminophen)
    59630091310 1
PDPs
10
MAPDs
ZOHYDRO ER 10 MG CAPSULE
(hydrocodone bitartrate)
    65224031060 14
PDPs
59
MAPDs
ZOHYDRO ER 15 MG CAPSULE
(hydrocodone bitartrate)
    65224031560 14
PDPs
59
MAPDs
ZOHYDRO ER 20 MG CAPSULE
(hydrocodone bitartrate)
    65224032060 14
PDPs
59
MAPDs
ZOHYDRO ER 30 MG CAPSULE
(hydrocodone bitartrate)
    65224033060 14
PDPs
58
MAPDs
ZOHYDRO ER 40 MG CAPSULE
(hydrocodone bitartrate)
    65224034060 14
PDPs
58
MAPDs
ZOHYDRO ER 50 MG CAPSULE
(hydrocodone bitartrate)
    65224035060 14
PDPs
58
MAPDs



(Chart Source: Centers for Medicare and Medicaid files: CMS Data January 2018)


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Tips & Disclaimers
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.