2013 Medicare Part D Plan Formulary Information |
Samaritan Advantage Premier Plan Plus (HMO) (H3811-009-0)
Benefit Details
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The Samaritan Advantage Premier Plan Plus (HMO) (H3811-009-0) Formulary Drugs Starting with the Letter H in LINN County, OR: CMS MA Region 23 which includes: OR
|
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 OR cover Halaven 0.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | None |
HALDOL DECANOATE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HALDOL DECANOATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
HALDOL DECANOATE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HALDOL DECANOATE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | 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 OR 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 |
$9.00 | $27.00 | 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 OR 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 |
$9.00 | $27.00 | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OR cover Halog 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OR 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 |
$80.00 | $240.00 | None |
HALOPERIDOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in OR cover Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL DEC 100MG/ML VL ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL DEC 100MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL LAC 2MG/ML CONC ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL LAC 2MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HALOPERIDOL LAC 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HALOPERIDOL LAC 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in OR 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 |
$40.00 | $120.00 | None |
HAVRIX HEPATITIS A VACCINE INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HECTOROL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HECTOROL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
HECTOROL 2.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HECTOROL 2.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hectorol 4ug/2mL ![Compare how all Medicare Part D PDP plans in OR cover Hectorol 4ug/2mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
HELIDAC THERAPY ![Compare how all Medicare Part D PDP plans in OR cover HELIDAC THERAPY.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
HEPARIN 25000U-1/2NS 250ML ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN 25000U-1/2NS 250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HEPARIN 25000U-1/2NS 500ML ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN 25000U-1/2NS 500ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
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 OR 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 |
$9.00 | $27.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | P |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in OR 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 |
$40.00 | $120.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPSERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
HERCEPTIN 440MG VIAL ![Compare how all Medicare Part D PDP plans in OR cover HERCEPTIN 440MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
HEXALEN CAPSULES ![Compare how all Medicare Part D PDP plans in OR cover HEXALEN CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG MIX KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG MIX KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMALOG MIX KWIKPEN INJECTION SUSPENSION ![Compare how all Medicare Part D PDP plans in OR cover HUMALOG MIX KWIKPEN INJECTION SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in OR cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in OR cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | N/A | P |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in OR cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | P |
Humira 2 KIT in 1 CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in OR cover Humira 2 KIT in 1 CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | P |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in OR cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | 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 OR 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) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | 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 OR 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) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$40.00 | $120.00 | None |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL ![Compare how all Medicare Part D PDP plans in OR cover HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYCET 7.5 MG-325 MG/15 ML SOL ![Compare how all Medicare Part D PDP plans in OR cover HYCET 7.5 MG-325 MG/15 ML SOL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDRALAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDRALAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDRALAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDRALAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDRALAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDRALAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDRALAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDRALAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDRALAZINE HYDROCHLORIDE INJECTION USP ![Compare how all Medicare Part D PDP plans in OR cover HYDRALAZINE HYDROCHLORIDE INJECTION USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCHLOROTHIAZIDE 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Hydrochlorothiazide 50mg/1 ![Compare how all Medicare Part D PDP plans in OR cover Hydrochlorothiazide 50mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCHLOROTHIAZIDE TABLETS 25MG ![Compare how all Medicare Part D PDP plans in OR cover HYDROCHLOROTHIAZIDE TABLETS 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
Hydrocodone Bitartrate and Acetaminophen 500; 7.5mg/1; mg/1 500 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN ORAL SOLUTION 500;7;7.5MG/15ML;% 4 FLO BOT ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
HYDROCODONE BITARTRATE AND ACETAMINOPHEN TABLET 7.5-650MG (500 CT) ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE-ACETAMINOPHEN 10-750MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE-ACETAMINOPHEN 10MG-500MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE-ACETAMINOPHEN 10MG-650MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE/APAP 10/325 TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE/APAP 10/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE/APAP 10/660 TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE/APAP 10/660 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE/APAP 2.5/500 TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE/APAP 2.5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE/APAP 5/500 TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE/APAP 5/500 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCODONE/APAP 7.5/750 TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCODONE/APAP 7.5/750 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE 0.2% CREAM ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | 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 OR 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 |
$9.00 | $27.00 | None |
HYDROCORTISONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydrocortisone 20mg 100 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in OR cover Hydrocortisone 20mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Hydrocortisone 25mg/g 1 TUBE in 1 TUBE / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OR 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) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | 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 OR 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 |
$9.00 | $27.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE BUTYR 0.1% OINT ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE BUTYR 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE CREAM 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE CREAM 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE LOTION 2.5% 2 OZ BOT ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE LOTION 2.5% 2 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE OINTMENT 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE OINTMENT 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX ![Compare how all Medicare Part D PDP plans in OR cover HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROMORPHONE HCL 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OR cover HYDROMORPHONE HCL 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydromorphone Hydrochloride 10mg/mL 1 VIAL in 1 CARTON / 50 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in OR 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 |
$9.00 | $27.00 | None |
HYDROMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in OR cover HYDROMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROMORPHONE HYDROCHLORIDE TABLETS ![Compare how all Medicare Part D PDP plans in OR cover HYDROMORPHONE HYDROCHLORIDE TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROXYCHLOROQUINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYCHLOROQUINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROXYUREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYUREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROXYZINE 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROXYZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | None |
HYDROXYZINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
Hydroxyzine Hydrochloride 10mg/1 ![Compare how all Medicare Part D PDP plans in OR cover Hydroxyzine Hydrochloride 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HydrOXYzine Hydrochloride 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in OR cover HydrOXYzine Hydrochloride 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
Hydroxyzine Hydrochloride 25mg/1 500 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in OR cover Hydroxyzine Hydrochloride 25mg/1 500 FILM COATED TABLETS in BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HYDROXYZINE PAM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE PAM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HYDROXYZINE PAMOATE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in OR cover HYDROXYZINE PAMOATE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$9.00 | $27.00 | P |
HYZAAR 100-12.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in OR cover HYZAAR 100-12.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
HYZAAR 100-25MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in OR cover HYZAAR 100-25MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$80.00 | $240.00 | None |
HYZAAR 12.5; 50mg/1; mg/1 1000 FILM COATED TABLETS in BOTTLE ![Compare how all Medicare Part D PDP plans in OR 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 |
$80.00 | $240.00 | None |