2010 Medicare Part D Plan Formulary Information |
Health Net Orange Option 1 (PDP) (S5678-056-0)
Benefit Details
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The Health Net Orange Option 1 (PDP) (S5678-056-0) Formulary Drugs Starting with the Letter H in CMS PDP Region 25 which includes: IA MN MT NE ND SD WY
|
Drugs Starting with Letter H
Drug Name |
Drug Tier Information |
Cost-Sharing |
Drug Usage Mgmt |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
HALDOL 5MG/ML AMPUL ![Compare how all Medicare Part D PDP plans in MN cover HALDOL 5MG/ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HALDOL DECANOATE 100 AMPUL ![Compare how all Medicare Part D PDP plans in MN cover HALDOL DECANOATE 100 AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HALDOL DECANOATE 50 AMPUL ![Compare how all Medicare Part D PDP plans in MN cover HALDOL DECANOATE 50 AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HALFLYTELY AND BISACODYL TABLETS BOWEL PREP KIT 5.6;2.86;GM;GM;GM; 1 PKGCOM ![Compare how all Medicare Part D PDP plans in MN cover HALFLYTELY AND BISACODYL TABLETS BOWEL PREP KIT 5.6;2.86;GM;GM;GM; 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | None |
HALOBETASOL PROPIONATE 0.05% CREAM ![Compare how all Medicare Part D PDP plans in MN cover HALOBETASOL PROPIONATE 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
HALOBETASOL PROPIONATE 0.05% OINTMENT ![Compare how all Medicare Part D PDP plans in MN cover HALOBETASOL PROPIONATE 0.05% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
HALOG 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in MN cover HALOG 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
HALOG 0.10% 60 GM ![Compare how all Medicare Part D PDP plans in MN cover HALOG 0.10% 60 GM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | Q:1 /1Days |
HALOPERIDOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL 10MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 10MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOPERIDOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL DEC 100MG/ML VL ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL DEC 100MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HALOPERIDOL LAC 2MG/ML CONC ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL LAC 2MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HALOPERIDOL LAC 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HALOPERIDOL LAC 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HAVRIX 720UNIT/0.5ML SYRINGE ![Compare how all Medicare Part D PDP plans in MN cover HAVRIX 720UNIT/0.5ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in MN cover HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HECTOROL 4 MCG/2ML AMPUL ![Compare how all Medicare Part D PDP plans in MN cover HECTOROL 4 MCG/2ML AMPUL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPARIN 25000U-1/2NS 250ML ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN 25000U-1/2NS 250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN 25000U-1/2NS 500ML ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN 25000U-1/2NS 500ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN NA 2000UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN NA 2000UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN NA 2500UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN NA 2500UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM 20MU/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM 20MU/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM IN 5% DEXTROSE INJECTION 25000UNITS 24 X 250ML BAG ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM IN 5% DEXTROSE INJECTION 25000UNITS 24 X 250ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM IN 5% DEXTROSE INJECTION SOLUTION 4000UNITS 24 X 500ML CTR ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM IN 5% DEXTROSE INJECTION SOLUTION 4000UNITS 24 X 500ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM IN 5% DEXTROSE INJECTION SOLUTION 5000UNITS 24 X 500ML CTR ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM IN 5% DEXTROSE INJECTION SOLUTION 5000UNITS 24 X 500ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM IN SODIUM CHLORIDE INJECTION ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM IN SODIUM CHLORIDE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM INJECTION 10000UNITS 25 X 5ML VIALMD ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM INJECTION 10000UNITS 25 X 5ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPARIN SODIUM INJECTION USP 1000UNITS 25 X 10ML VIALMD ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM INJECTION USP 1000UNITS 25 X 10ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPARIN SODIUM INJECTION USP 5000UNITS 25 X 10ML VIALMD ![Compare how all Medicare Part D PDP plans in MN cover HEPARIN SODIUM INJECTION USP 5000UNITS 25 X 10ML VIALMD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in MN cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | P |
HEPATASOL INJECTION 8% 500ML BAG ![Compare how all Medicare Part D PDP plans in MN cover HEPATASOL INJECTION 8% 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | P |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in MN cover HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | P |
HEPSERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | P |
HERCEPTIN 440MG VIAL ![Compare how all Medicare Part D PDP plans in MN cover HERCEPTIN 440MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | None |
HEXALEN 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MN cover HEXALEN 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | None |
HIBTITER VACCINE VIAL ![Compare how all Medicare Part D PDP plans in MN cover HIBTITER VACCINE VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HUMALOG 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:2 /1Days |
HUMALOG 100UNITS/ML PEN ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG 100UNITS/ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | P Q:45 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMALOG MIX 50/50 PEN ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG MIX 50/50 PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | P Q:45 /30Days |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:2 /1Days |
HUMALOG MIX 75/25 PEN ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG MIX 75/25 PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | P Q:45 /30Days |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:2 /1Days |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in MN cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in MN cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in MN cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMATROPE FOR INJECTION 5MG 6 X 5ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMATROPE FOR INJECTION 5MG 6 X 5ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMIRA 40MG/0.8ML SYRINGE ![Compare how all Medicare Part D PDP plans in MN cover HUMIRA 40MG/0.8ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in MN cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | P |
HUMULIN 50/50 VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:1 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMULIN 70/30 PEN INJECTION 100UNT 1 X 3.0ML(PEN) CTG ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN 70/30 PEN INJECTION 100UNT 1 X 3.0ML(PEN) CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:45 /30Days |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:1 /1Days |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:1 /1Days |
HUMULIN N PEN INJECTION 100UNT 1 X 3.0ML (PEN) CTG ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN N PEN INJECTION 100UNT 1 X 3.0ML (PEN) CTG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:45 /30Days |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:1 /1Days |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Tier 2 Preferred Brand |
$40.00 | $80.00 | Q:1 /1Days |
HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL ![Compare how all Medicare Part D PDP plans in MN cover HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Tier 5 Specialty |
25% | N/A | None |
HYCET SOL 7.5-325 ![Compare how all Medicare Part D PDP plans in MN cover HYCET SOL 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
HYDRALAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDRALAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDRALAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDRALAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDRALAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDRALAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDRALAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDRALAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDRALAZINE HCL INJECTION 20MG 25 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in MN cover HYDRALAZINE HCL INJECTION 20MG 25 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HYDROCHLORIDE 50MG TABLET (1000 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROCHLORIDE 50MG TABLET (1000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCHLOROTHIAZIDE 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
HYDROCHLOROTHIAZIDE 25MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCHLOROTHIAZIDE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN ORAL SOLUTION 500;7;7.5MG/15ML;% 4 FLO BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE BITARTRATE AND ACETAMINOPHEN ORAL SOLUTION 500;7;7.5MG/15ML;% 4 FLO BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 500-7.5MG (120 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 500-7.5MG (120 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 7.5-650MG (500 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 7.5-650MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | None |
HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE/APAP 10/325 TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE/APAP 10/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE/APAP 10/660 TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE/APAP 10/660 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE/APAP 2.5/500 TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE/APAP 2.5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE/APAP 5/500 TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE/APAP 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODONE/APAP 7.5/750 TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCODONE/APAP 7.5/750 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCORTISONE 0.2% CREAM ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROCORTISONE 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE 1% LOTION 118ML ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 1% LOTION 118ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
HYDROCORTISONE 1% OINTMENT ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROCORTISONE 100MG ENEMA ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 100MG ENEMA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCORTISONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCORTISONE 20MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 20MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCORTISONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROCORTISONE BUTYRATE 0.1% CREAM ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE BUTYRATE 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROCORTISONE BUTYRATE 0.1% OINTMENT ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE BUTYRATE 0.1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROCORTISONE BUTYRATE 0.1% SOLUTION NON-ORAL ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE BUTYRATE 0.1% SOLUTION NON-ORAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
HYDROCORTISONE CREAM 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE CREAM 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:3 /1Days |
HYDROCORTISONE CREAM USP 2.5% 20GM TUBE ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE CREAM USP 2.5% 20GM TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE LOTION 2.5% 2 OZ BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE LOTION 2.5% 2 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:4 /1Days |
HYDROCORTISONE OINTMENT 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE OINTMENT 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX ![Compare how all Medicare Part D PDP plans in MN cover HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | Q:2 /1Days |
HYDROMORPHON INJ 10MG/ML ![Compare how all Medicare Part D PDP plans in MN cover HYDROMORPHON INJ 10MG/ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HYDROMORPHONE HCL 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROMORPHONE HCL 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROMORPHONE HYDROCHLORIDE TABLETS USP 2MG 100 BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROMORPHONE HYDROCHLORIDE TABLETS USP 2MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROMORPHONE HYDROCHLORIDE TABLETS USP 4MG 100 BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROMORPHONE HYDROCHLORIDE TABLETS USP 4MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYCHLOROQUINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYCHLOROQUINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYUREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYUREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
HYDROXYZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Tier 4 Injectable |
25% | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROXYZINE HCL 10MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE HCL 10MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE HCL 10MG/5ML ORAL SOLUTION 1 PT BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE HCL 10MG/5ML ORAL SOLUTION 1 PT BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE HCL 25MG TABLET ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE HCL 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE PAM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE PAM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYDROXYZINE PAMOATE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in MN cover HYDROXYZINE PAMOATE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Tier 1 Preferred Generic |
$4.00 | $8.00 | None |
HYZAAR 100-12.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYZAAR 100-12.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | S Q:1 /1Days |
HYZAAR 100-25MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYZAAR 100-25MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | S Q:1 /1Days |
HYZAAR 50-12.5MG TABLET (5000 CT) ![Compare how all Medicare Part D PDP plans in MN cover HYZAAR 50-12.5MG TABLET (5000 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Tier 3 Non-Preferred |
$95.00 | $238.00 | S Q:1 /1Days |