2013 Medicare Part D Plan Formulary Information |
Today''s Options Advantage Plus 650F (PPO) (H2775-091-0)
Benefit Details
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The Today''s Options Advantage Plus 650F (PPO) (H2775-091-0) Formulary Drugs Starting with the Letter H in MONTGOMERY County, PA: CMS MA Region 6 which includes: PA
|
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 |
Halaven 0.5mg/mL ![Compare how all Medicare Part D PDP plans in PA cover Halaven 0.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HALDOL DECANOATE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HALDOL DECANOATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALDOL DECANOATE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HALDOL DECANOATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALDOL INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HALDOL INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HalfLytely and Bisacodyl Bowel Prep with Flavor Packs 1 KIT in 1 CARTON ![Compare how all Medicare Part D PDP plans in PA cover HalfLytely and Bisacodyl Bowel Prep with Flavor Packs 1 KIT in 1 CARTON.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Halobetasol Propionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Halobetasol Propionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Halobetasol Propionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Halobetasol Propionate 0.5mg/g 1 TUBE in 1 CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Halog 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover HALOG OINTMENT 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALOPERIDOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL DEC 100MG/ML VL ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL DEC 100MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL LAC 2MG/ML CONC ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL LAC 2MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HALOPERIDOL LAC 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HALOPERIDOL LAC 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HAVRIX HEPATITIS A VACCINE INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HECTOROL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover HECTOROL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P |
HECTOROL 2.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover HECTOROL 2.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P |
Hectorol 4ug/2mL ![Compare how all Medicare Part D PDP plans in PA cover Hectorol 4ug/2mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | P |
HELIDAC THERAPY ![Compare how all Medicare Part D PDP plans in PA cover HELIDAC THERAPY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HEPARIN 25000U-1/2NS 250ML ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN 25000U-1/2NS 250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HEPARIN 25000U-1/2NS 500ML ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN 25000U-1/2NS 500ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
Heparin Sodium in Dextrose 5; 4000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTA ![Compare how all Medicare Part D PDP plans in PA cover Heparin Sodium in Dextrose 5; 4000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTA.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR ![Compare how all Medicare Part D PDP plans in PA cover HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in PA cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HEPATASOL INJECTION 8% 500ML BAG ![Compare how all Medicare Part D PDP plans in PA cover HEPATASOL INJECTION 8% 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in PA cover HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | P |
HEPSERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | S |
HERCEPTIN 440MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover HERCEPTIN 440MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HEXALEN CAPSULES ![Compare how all Medicare Part D PDP plans in PA cover HEXALEN CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | None |
HIPREX 1GM TABLET ![Compare how all Medicare Part D PDP plans in PA cover HIPREX 1GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HORIZANT 600mg/1 30 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover HORIZANT 600mg/1 30 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG MIX KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG MIX KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG MIX KWIKPEN INJECTION SUSPENSION ![Compare how all Medicare Part D PDP plans in PA cover HUMALOG MIX KWIKPEN INJECTION SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in PA cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
Humira 2 KIT in 1 CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in PA cover Humira 2 KIT in 1 CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in PA cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
Humulin 70/30 100[iU]/mL 5 SYRINGE in 1 CARTON / 3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover Humulin 70/30 100[iU]/mL 5 SYRINGE in 1 CARTON / 3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Humulin N 100[iU]/mL 5 SYRINGE in 1 CARTON / 3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in PA cover Humulin N 100[iU]/mL 5 SYRINGE in 1 CARTON / 3 mL in 1 SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | P |
HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
29% | N/A | P |
HYCET 7.5 MG-325 MG/15 ML SOL ![Compare how all Medicare Part D PDP plans in PA cover HYCET 7.5 MG-325 MG/15 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | Q:5400 /30Days |
HYDRALAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDRALAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDRALAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDRALAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDRALAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDRALAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDRALAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDRALAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDRALAZINE HYDROCHLORIDE INJECTION USP ![Compare how all Medicare Part D PDP plans in PA cover HYDRALAZINE HYDROCHLORIDE INJECTION USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover HYDREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCHLOROTHIAZIDE 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
Hydrochlorothiazide 50mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Hydrochlorothiazide 50mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROCHLOROTHIAZIDE TABLETS 25MG ![Compare how all Medicare Part D PDP plans in PA cover HYDROCHLOROTHIAZIDE TABLETS 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:400 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:400 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in PA cover Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:400 /30Days |
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL ![Compare how all Medicare Part D PDP plans in PA cover Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:5400 /30Days |
Hydrocodone Bitartrate and Acetaminophen 500; 7.5mg/1; mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in PA cover Hydrocodone Bitartrate and Acetaminophen 500; 7.5mg/1; mg/1 500 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN ORAL SOLUTION 500;7;7.5MG/15ML;% 4 FLO BOT ![Compare how all Medicare Part D PDP plans in PA 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) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:3600 /30Days |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 7.5-650MG (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 7.5-650MG (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:185 /30Days |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:150 /30Days |
HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:160 /30Days |
HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:240 /30Days |
HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:185 /30Days |
HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:360 /30Days |
HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:360 /30Days |
HYDROCODONE/APAP 10/325 TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE/APAP 10/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:360 /30Days |
HYDROCODONE/APAP 10/660 TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE/APAP 10/660 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:181 /30Days |
HYDROCODONE/APAP 2.5/500 TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE/APAP 2.5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:240 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE/APAP 5/500 TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE/APAP 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:240 /30Days |
HYDROCODONE/APAP 7.5/750 TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCODONE/APAP 7.5/750 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | Q:160 /30Days |
HYDROCORTISONE 0.001 MG/MG TOPICAL OINTMENT [LOCOID] ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 0.001 MG/MG TOPICAL OINTMENT [LOCOID].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HYDROCORTISONE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE 0.2% CREAM ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE 1 MG/ML TOPICAL SOLUTION [LOCOID] ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 1 MG/ML TOPICAL SOLUTION [LOCOID].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Hydrocortisone 100mg/60mL 7 BOTTLE, WITH APPLICATOR in 1 BOX / 60 mL in 1 BOTTLE, WITH APPLICATOR ![Compare how all Medicare Part D PDP plans in PA cover Hydrocortisone 100mg/60mL 7 BOTTLE, WITH APPLICATOR in 1 BOX / 60 mL in 1 BOTTLE, WITH APPLICATOR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Hydrocortisone 20mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Hydrocortisone 20mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Hydrocortisone 25mg/g 1 TUBE in 1 TUBE / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in PA cover Hydrocortisone 25mg/g 1 TUBE in 1 TUBE / 30 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Hydrocortisone and Acetic Acid 2.41; 3.15g/100mL; g/100mL 1 BOTTLE in 1 CARTON / 10 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover Hydrocortisone and Acetic Acid 2.41; 3.15g/100mL; g/100mL 1 BOTTLE in 1 CARTON / 10 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE BUTYR 0.1% OINT ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE BUTYR 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE CREAM 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE CREAM 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROCORTISONE LOTION 2.5% 2 OZ BOT ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE LOTION 2.5% 2 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROCORTISONE OINTMENT 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE OINTMENT 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX ![Compare how all Medicare Part D PDP plans in PA cover HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROMORPHONE HCL 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYDROMORPHONE HCL 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Hydromorphone Hydrochloride 10mg/mL 1 VIAL in 1 CARTON / 50 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in PA cover Hydromorphone Hydrochloride 10mg/mL 1 VIAL in 1 CARTON / 50 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | P |
HYDROMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover HYDROMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in PA cover HYDROMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROXYCHLOROQUINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYDROXYCHLOROQUINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$5.00 | $10.00 | None |
HYDROXYUREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in PA cover HYDROXYUREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROXYZINE 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HYDROXYZINE 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYDROXYZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in PA cover HYDROXYZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$12.00 | $24.00 | None |
HYZAAR 100-12.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYZAAR 100-12.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HYZAAR 100-25MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in PA cover HYZAAR 100-25MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HYZAAR 12.5; 50mg/1; mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in PA cover HYZAAR 12.5; 50mg/1; mg/1 1000 FILM COATED TABLETS in BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |