2014 Medicare Part D Plan Formulary Information |
Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) (H0524-030-0)
Benefit Details
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The Senior Advantage Medicare Medi-Cal Plan North (HMO SNP) (H0524-030-0) Formulary Drugs Starting with the Letter H in STANISLAUS County, CA: CMS MA Region 24 which includes: CA Plan Monthly Premium: $9.50 Deductible: $0 |
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 |
H.P. ACTHAR GEL 80 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover H.P. ACTHAR GEL 80 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Halaven 0.5mg/mL ![Compare how all Medicare Part D PDP plans in CA cover Halaven 0.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
Halcion 0.25mg/1 100 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in CA cover Halcion 0.25mg/1 100 TABLET per BLISTER PACK.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALDOL 5MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HALDOL 5MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALDOL DECANOATE 100MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HALDOL DECANOATE 100MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HALDOL DECANOATE 50MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HALDOL DECANOATE 50MG/ML 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 per CARTON ![Compare how all Medicare Part D PDP plans in CA cover HalfLytely and Bisacodyl Bowel Prep with Flavor Packs 1 KIT per 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 per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA cover Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
halobetasol propionate 0.5mg/g 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA cover halobetasol propionate 0.5mg/g 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA 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 |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG] ![Compare how all Medicare Part D PDP plans in CA cover HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG].](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 CA cover HALOPERIDOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CA cover Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL DEC 100MG/ML VL ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL DEC 100MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL LAC 2MG/ML CONC ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL LAC 2MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HALOPERIDOL LAC 5MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL LAC 5MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in CA cover HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
HAVRIX HEPATITIS A VACCINE INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
HECTOROL 0.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in CA 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 CA 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 CA cover Hectorol 4ug/2mL.](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 CA cover HEPARIN 25000U-1/2NS 250ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HEPARIN 25000U-1/2NS 500ML ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN 25000U-1/2NS 500ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | 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 CA 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 |
$13.00 | $26.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HEPARIN SODIUM INJECTION SOLUTION 200UNITS 12 X 1000ML CTR ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in CA cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HEPATASOL INJECTION 8% 500ML BAG ![Compare how all Medicare Part D PDP plans in CA cover HEPATASOL INJECTION 8% 500ML BAG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in CA cover HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | P |
HEPSERA 10MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HERCEPTIN 440MG VIAL ![Compare how all Medicare Part D PDP plans in CA cover HERCEPTIN 440MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HETLIOZ 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HETLIOZ 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HEXALEN 50MG CAPSULES ![Compare how all Medicare Part D PDP plans in CA cover HEXALEN 50MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HIPREX 1GM TABLET ![Compare how all Medicare Part D PDP plans in CA 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 CA 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 |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HORIZANT ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HORIZANT ER 300 MG TABLET.](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 CA cover HUMALOG 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in CA 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 CA 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 CA 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 CA 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 CA cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Humira 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in CA cover Humira 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | 25% | None |
Humulin 70/30 100[iU]/mL 5 SYRINGE per CARTON / 3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in CA cover Humulin 70/30 100[iU]/mL 5 SYRINGE per 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 70/30 VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
Humulin N 100[iU]/mL 5 SYRINGE per CARTON / 3 mL in 1 SYRINGE ![Compare how all Medicare Part D PDP plans in CA cover Humulin N 100[iU]/mL 5 SYRINGE per 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 CA cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | P |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | None |
HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL ![Compare how all Medicare Part D PDP plans in CA cover HYCAMTIN POWDER FOR INJECTION SOLUTION 4MG 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$95.00 | $190.00 | None |
HYCET 7.5 MG-325 MG/15 ML SOL ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HYDRALAZINE 100MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 100MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDRALAZINE 10MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
HYDRALAZINE 25MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 25MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
HYDRALAZINE 50MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 50MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDRALAZINE HYDROCHLORIDE 20MG/ML INJECTION USP ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE HYDROCHLORIDE 20MG/ML INJECTION USP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA 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 CA cover HYDROCHLOROTHIAZIDE 12.5MG CAPSULE (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
HYDROCHLOROTHIAZIDE 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCHLOROTHIAZIDE 50 MG TAB ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
HYDROCHLOROTHIAZIDE TABLETS 25MG ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE TABLETS 25MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$8.00 | $16.00 | None |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCODONE/APAP 10/325 TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE/APAP 10/325 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE 0.2% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | 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 CA 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 |
$13.00 | $26.00 | None |
HYDROCORTISONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | 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 CA cover Hydrocortisone 20mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Hydrocortisone 25mg/g 1 TUBE in 1 TUBE / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HYDROCORTISONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Hydrocortisone and Acetic Acid 2.41; 3.15g/100mL; g/100mL 1 BOTTLE per CARTON / 10 mL in 1 BOTTLE ![Compare how all Medicare Part D PDP plans in CA cover Hydrocortisone and Acetic Acid 2.41; 3.15g/100mL; g/100mL 1 BOTTLE per CARTON / 10 mL in 1 BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE BUTYR 0.1% OINT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE BUTYR 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE BUTYRATE 0.1% lipo cream ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE BUTYRATE 0.1% lipo cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE CREAM 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE CREAM 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE LOTION 2.5% 2 OZ BOT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE LOTION 2.5% 2 OZ BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE OINTMENT 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE OINTMENT 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROMORPHONE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROMORPHONE HCL 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE HCL 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Hydromorphone Hydrochloride 10mg/mL 1 VIAL per CARTON / 50 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in CA cover Hydromorphone Hydrochloride 10mg/mL 1 VIAL per CARTON / 50 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROMORPHONE HYDROCHLORIDE 4MG TABLETS ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE HYDROCHLORIDE 4MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYCHLOROQUINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYCHLOROQUINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYUREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYUREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYZINE 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYZINE HCL TABLETS 50MG 100 BOT ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE HCL TABLETS 50MG 100 BOT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Hydroxyzine Hydrochloride 10mg/1 ![Compare how all Medicare Part D PDP plans in CA cover Hydroxyzine Hydrochloride 10mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HydrOXYzine Hydrochloride 10mg/5mL 473 mL in 1 BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
Hydroxyzine Hydrochloride 25mg/1 500 FILM COATED TABLETS in BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in CA 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 |
$13.00 | $26.00 | None |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYZINE PAM 50MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE PAM 50MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYDROXYZINE PAMOATE 25MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE PAMOATE 25MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Non-Preferred Generic |
$13.00 | $26.00 | None |
HYZAAR 100-12.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in CA 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 CA 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 CA 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 |