2018 Medicare Part D Plan Formulary Information |
Cigna-HealthSpring Rx Secure (PDP) (S5617-163-0)
Benefit Details
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The Cigna-HealthSpring Rx Secure (PDP) (S5617-163-0) Formulary Drugs Starting with the Letter H in CMS PDP Region 33 which includes: HI Plan Monthly Premium: $42.50 Deductible: $405 Qualifies for LIS: No |
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 HI cover Halaven 0.5mg/mL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
HALOBETASOL PROP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HALOBETASOL PROP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in 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 |
$7.00 | $21.00 | None |
HALOPERIDOL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HALOPERIDOL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HALOPERIDOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | None |
HALOPERIDOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HALOPERIDOL LAC 2 MG/ML CONC ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL LAC 2 MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HALOPERIDOL LAC 5 MG/ML SYRING ![Compare how all Medicare Part D PDP plans in HI cover HALOPERIDOL LAC 5 MG/ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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 Q:28 /28Days |
HAVRIX 1,440 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in HI cover HAVRIX 1,440 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HAVRIX 720 UNITS/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HAVRIX 720 UNITS/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HEPARIN SOD 1,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HEPARIN SOD 1,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HEPARIN SOD 5,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HEPARIN SOD 5,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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 Drug |
46% | 46% | P |
Hepatitis B Surface Antigen Vaccine 0.01 MG/ML Prefilled 0.5 ML Syringe [Recombivax] ![Compare how all Medicare Part D PDP plans in HI cover Hepatitis B Surface Antigen Vaccine 0.01 MG/ML Prefilled 0.5 ML Syringe [Recombivax].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | P Q:3 /365Days |
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) |
4 |
Non-Preferred Drug |
46% | 46% | P Q:3 /365Days |
HERCEPTIN 150 MG VIAL ![Compare how all Medicare Part D PDP plans in HI cover HERCEPTIN 150 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P |
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) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 | P Q:30 /30Days |
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) |
4 |
Non-Preferred Drug |
46% | 46% | None |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | None |
HUMALOG 100 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG 100 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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) |
3 |
Preferred Brand |
$35.00 | $105.00 | None |
HUMALOG JR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in HI cover HUMALOG JR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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) |
3 |
Preferred Brand |
$35.00 | $105.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | None |
HUMIRA 10 MG/0.1 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 10 MG/0.1 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
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 | P Q:2 /28Days |
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 | P Q:4 /28Days |
HUMIRA 20 MG/0.2 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 20 MG/0.2 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:2 /28Days |
HUMIRA 40 MG/0.4 ML PEN IJ KIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 40 MG/0.4 ML PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
HUMIRA 40 MG/0.4 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA 40 MG/0.4 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:4 /28Days |
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 | P Q:4 /28Days |
HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:6 /365Days |
HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT ![Compare how all Medicare Part D PDP plans in HI cover HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
25% | N/A | P Q:4 /365Days |
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 | P Q:6 /365Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 | P Q:6 /365Days |
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 | P Q:12 /365Days |
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 | P Q:8 /365Days |
HUMULIN 70/30 KWIKPEN ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN 70/30 KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | 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 |
$35.00 | $105.00 | None |
HUMULIN N 100 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in HI cover HUMULIN N 100 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | None |
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 |
$35.00 | $105.00 | 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 |
$35.00 | $105.00 | None |
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 |
$35.00 | $105.00 | 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 |
$35.00 | $105.00 | 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) |
2 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$7.00 | $21.00 | 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) |
4 |
Non-Preferred Drug |
46% | 46% | 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) |
2 |
Generic |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | None |
Hydrochlorothiazide 12.5 MG Oral Capsule ![Compare how all Medicare Part D PDP plans in HI cover Hydrochlorothiazide 12.5 MG Oral Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | None |
HYDROCHLOROTHIAZIDE 12.5 MG TB ![Compare how all Medicare Part D PDP plans in HI cover HYDROCHLOROTHIAZIDE 12.5 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | 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 |
$2.00 | $6.00 | None |
HYDROCHLOROTHIAZIDE 50 MG TAB ![Compare how all Medicare Part D PDP plans in HI cover HYDROCHLOROTHIAZIDE 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | None |
HYDROCODON-ACETAMINOPH 2.5-325 ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODON-ACETAMINOPH 2.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:360 /30Days |
HYDROCODON-ACETAMINOPH 7.5-325 ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODON-ACETAMINOPH 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
HYDROCODON-ACETAMINOPHEN 5-325 ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODON-ACETAMINOPHEN 5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:360 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODON-ACETAMINOPHN 10-325 ![Compare how all Medicare Part D PDP plans in HI cover HYDROCODON-ACETAMINOPHN 10-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:360 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:2700 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:150 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:150 /30Days |
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) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:150 /30Days |
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 |
$7.00 | $21.00 | None |
HYDROCORTISONE 1% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | None |
HYDROCORTISONE 1% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort] ![Compare how all Medicare Part D PDP plans in HI cover Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | 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 |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | None |
HYDROCORTISONE 2.5% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1 |
Preferred Generic |
$2.00 | $6.00 | 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 |
$7.00 | $21.00 | None |
HYDROCORTISONE 2.5% OINTMENT ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE 2.5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
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 |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | 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 |
$7.00 | $21.00 | None |
HYDROCORTISONE VAL 0.2% CREAM ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE VAL 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE VAL 0.2% OINTMT ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE VAL 0.2% OINTMT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HYDROCORTISONE-ACETIC ACID SOLN ![Compare how all Medicare Part D PDP plans in HI cover HYDROCORTISONE-ACETIC ACID SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | None |
HYDROMORPHONE 1 MG/ML SOLUTION [Dilaudid] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 1 MG/ML SOLUTION [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:1200 /30Days |
HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HYDROMORPHONE 2 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 2 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
HYDROMORPHONE 2 MG/ML ISECURE Syringe [Simplist Dilaudid] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 2 MG/ML ISECURE Syringe [Simplist Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HYDROMORPHONE 4 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 4 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:180 /30Days |
HYDROMORPHONE 50 MG/5 ML VIAL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 50 MG/5 ML VIAL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
46% | 46% | None |
HYDROMORPHONE 8 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in HI cover HYDROMORPHONE 8 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$35.00 | $105.00 | Q:120 /30Days |
HYDROXYCHLOROQUINE 200 MG TAB ![Compare how all Medicare Part D PDP plans in HI cover HYDROXYCHLOROQUINE 200 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2 |
Generic |
$7.00 | $21.00 | 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) |
5 |
Specialty Tier |
25% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
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 |
$7.00 | $21.00 | None |