2017 Medicare Part D Plan Formulary Information |
Kaiser Permanente Senior Advantage Hawaii Island (HMO) (H1230-014-0)
Benefit Details
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The Kaiser Permanente Senior Advantage Hawaii Island (HMO) (H1230-014-0) Formulary Drugs Starting with the Letter H in Hawaii County, HI: CMS MA Region 25 which includes: HI Plan Monthly Premium: $194.00 Deductible: $400 |
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 HI cover H.P. ACTHAR GEL 80 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Halaven 0.5mg/mL ![Compare how all Medicare Part D PDP plans in HI cover Halaven 0.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Halcion 0.25mg/1 100 TABLET per BLISTER PACK ![Compare how all Medicare Part D PDP plans in HI 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 |
$100.00 | N/A | None |
HALDOL 5MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HALDOL 5MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HALDOL DECANOATE 100MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HALDOL DECANOATE 100MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HALDOL DECANOATE 50MG/ML INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HALDOL DECANOATE 50MG/ML INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI 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 |
Generic |
$13.00 | N/A | None |
halobetasol propionate 0.5mg/g 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover halobetasol propionate 0.5mg/g 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI cover Halog 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG] ![Compare how all Medicare Part D PDP plans in HI 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 |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOPERIDOL 0.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 0.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC ![Compare how all Medicare Part D PDP plans in HI cover Haloperidol 10mg/1 100 TABLET BOTTLE, PLASTIC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL 1MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 1MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL DEC 100MG/ML VL ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL DEC 100MG/ML VL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL LAC 2MG/ML CONC ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL LAC 2MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HALOPERIDOL LAC 5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL LAC 5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HARVONI 90-400 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HARVONI 90-400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
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 HI 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 HI 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 HI cover HECTOROL 0.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P |
HECTOROL 2.5MCG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover HECTOROL 2.5MCG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | P |
Hectorol 4ug/2mL ![Compare how all Medicare Part D PDP plans in HI cover Hectorol 4ug/2mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Heparin Sodium in Dextrose 5; 10000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 250 mL in 1 CONT ![Compare how all Medicare Part D PDP plans in HI cover Heparin Sodium in Dextrose 5; 10000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 250 mL in 1 CONT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | 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 HI 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 |
Generic |
$13.00 | N/A | None |
Heparin Sodium in Dextrose 5; 5000g/100mL; [USP'U]/100mL 24 CONTAINER in 1 CASE / 500 mL in 1 CONTA ![Compare how all Medicare Part D PDP plans in HI cover Heparin Sodium in Dextrose 5; 5000g/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 |
Generic |
$13.00 | N/A | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | 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 HI cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in HI cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in HI 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 HI cover HEPSERA 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HERCEPTIN 440MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover HERCEPTIN 440MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HETLIOZ 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover HETLIOZ 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HEXALEN 50MG CAPSULES ![Compare how all Medicare Part D PDP plans in HI cover HEXALEN 50MG CAPSULES.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HIBERIX VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in HI cover HIBERIX VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
6 |
Vaccines |
$0.00 | N/A | None |
HIPREX 1 GM TABLET ![Compare how all Medicare Part D PDP plans in HI cover HIPREX 1 GM TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HORIZANT ER 300 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HORIZANT ER 300 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HORIZANT ER 600 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HORIZANT ER 600 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMALOG 100 UNITS/ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG 100 UNITS/ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
Humalog 100[iU]/mL 1 VIAL in 1 CARTON / 3 mL in 1 VIAL ![Compare how all Medicare Part D PDP plans in HI cover Humalog 100[iU]/mL 1 VIAL in 1 CARTON / 3 mL in 1 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HUMALOG 200 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG 200 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMALOG MIX KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG MIX KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMALOG MIX KWIKPEN INJECTION SUSPENSION ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG MIX KWIKPEN INJECTION SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in HI cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in HI cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in HI cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
HUMIRA 10 MG/0.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 10 MG/0.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
Humira 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in HI 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% | N/A | None |
HUMIRA 40 MG/0.8 ML PEN ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 40 MG/0.8 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HUMIRA PEN PSORIASIS-UVEITIS ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PEN PSORIASIS-UVEITIS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | None |
HUMULIN 70-30 PEN ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN 70-30 PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HUMULIN N 100 UNITS/ML PEN ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN N 100 UNITS/ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | P |
HUMULIN R 500 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN R 500 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HYCAMTIN 4 MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYCAMTIN 4 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYCET 7.5 MG-325 MG/15 ML SOLN ![Compare how all Medicare Part D PDP plans in HI cover HYCET 7.5 MG-325 MG/15 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDRALAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDRALAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | N/A | None |
HYDRALAZINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDRALAZINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDRALAZINE 20 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYDRALAZINE 20 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDRALAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDRALAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | N/A | None |
HYDRALAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDRALAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDREA 500MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover HYDREA 500MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYDROCHLOROTHIAZIDE 12.5 MG CP ![Compare how all Medicare Part D PDP plans in HI cover HYDROCHLOROTHIAZIDE 12.5 MG CP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | N/A | None |
HYDROCHLOROTHIAZIDE 12.5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROCHLOROTHIAZIDE 12.5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrochlorothiazide 25 mg tab ![Compare how all Medicare Part D PDP plans in HI cover Hydrochlorothiazide 25 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | N/A | None |
Hydrochlorothiazide 50mg/1 1000 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Hydrochlorothiazide 50mg/1 1000 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$4.00 | N/A | None |
Hydrocodone Acetaminophen 2.5-325 ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Acetaminophen 2.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocodone Acetaminophen 325; 10mg/1; mg/1 500 TABLET BOTTLE ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Acetaminophen 325; 10mg/1; mg/1 500 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL ![Compare how all Medicare Part D PDP plans in HI cover Hydrocodone Bitartrate and Acetaminophen 325; 7.5mg/15mL; mg/15mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODONE-ACETAMINOPHEN 5MG-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODONE-ACETAMINOPHEN 7.5-325MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCODONE-IBUPROFEN 10-200 ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODONE-IBUPROFEN 10-200.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCODONE-IBUPROFEN 5-200 MG ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODONE-IBUPROFEN 5-200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 0.2% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 0.2% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 0.2% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 100 MG/60 ML ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 100 MG/60 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 10MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 10MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 2.5% LOTION ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 2.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | 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 HI cover Hydrocortisone 20mg 100 TABLET BOTTLE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydrocortisone 25mg/g 1 TUBE in 1 TUBE / 30 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in HI 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 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE 5MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 5MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | 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 HI 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 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE BUTYR 0.1% OINT ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE BUTYR 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE BUTYRATE 0.1% lipo cream ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE BUTYRATE 0.1% lipo cream.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE CREAM 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE CREAM 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE OINTMENT 1% 1 LB JAR ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE OINTMENT 1% 1 LB JAR.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE OINTMENT USP 2.5% 20GM TUBE BOX.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROMORPHONE 1 MG/ML SOLUTION ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 1 MG/ML SOLUTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROMORPHONE 10 MG/ML 5ML ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 10 MG/ML 5ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROMORPHONE 10 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 10 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydromorphone 2 mg/ml Syringe ![Compare how all Medicare Part D PDP plans in HI cover Hydromorphone 2 mg/ml Syringe.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROMORPHONE HCL 8MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE HCL 8MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydromorphone hcl er 12 mg tab ![Compare how all Medicare Part D PDP plans in HI cover Hydromorphone hcl er 12 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydromorphone hcl er 16 mg tab ![Compare how all Medicare Part D PDP plans in HI cover Hydromorphone hcl er 16 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydromorphone hcl er 8 mg tab ![Compare how all Medicare Part D PDP plans in HI cover Hydromorphone hcl er 8 mg tab.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE HYDROCHLORIDE 2MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROMORPHONE HYDROCHLORIDE 4MG TABLETS ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE HYDROCHLORIDE 4MG TABLETS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYCHLOROQUINE 200MG TABLET (500 CT) ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYCHLOROQUINE 200MG TABLET (500 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydroxyprogesterone 1.25 g/5ml [MAKENA] ![Compare how all Medicare Part D PDP plans in HI cover Hydroxyprogesterone 1.25 g/5ml [MAKENA].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydroxyurea 500 mg capsule ![Compare how all Medicare Part D PDP plans in HI cover Hydroxyurea 500 mg capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROXYZINE 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYZINE 25MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE 25MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYZINE 50MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE 50MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYZINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYZINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydroxyzine hcl 50 mg tablet ![Compare how all Medicare Part D PDP plans in HI cover Hydroxyzine hcl 50 mg tablet.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydroxyzine pam 25 mg cap ![Compare how all Medicare Part D PDP plans in HI cover Hydroxyzine pam 25 mg cap.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
Hydroxyzine pam 50 mg cap ![Compare how all Medicare Part D PDP plans in HI cover Hydroxyzine pam 50 mg cap.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$13.00 | N/A | None |
HYPERRAB S-D 150 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYPERRAB S-D 150 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
HYPERRAB S-D 150 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HYPERRAB S-D 150 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | N/A | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYSINGLA ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYSINGLA ER 80 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYSINGLA ER 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYZAAR 100-12.5MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in HI cover HYZAAR 100-12.5MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYZAAR 100-25MG TABLET (90 CT) ![Compare how all Medicare Part D PDP plans in HI cover HYZAAR 100-25MG TABLET (90 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |
HYZAAR 50-12.5 TABLET ![Compare how all Medicare Part D PDP plans in HI cover HYZAAR 50-12.5 TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Brand |
$100.00 | N/A | None |