2019 Medicare Part D Plan Formulary Information |
Aetna Better Health of Ohio Dual Preferred (HMO SNP) (H5337-001-0)
Benefit Details
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The Aetna Better Health of Ohio Dual Preferred (HMO SNP) (H5337-001-0) Formulary Drugs Starting with the Letter H in Ottawa County, OH: CMS MA Region 12 which includes: OH Plan Monthly Premium: $32.10 Deductible: $220 |
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 |
HAEGARDA 2,000 UNIT VIAL ![Compare how all Medicare Part D PDP plans in OH cover HAEGARDA 2,000 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:30 /30Days |
HAEGARDA 3,000 UNIT VIAL ![Compare how all Medicare Part D PDP plans in OH cover HAEGARDA 3,000 UNIT VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:20 /30Days |
HAILEY 24 FE 1 MG-20 MCG TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in OH cover HAILEY 24 FE 1 MG-20 MCG TABLET [Tarina Fe 1/20].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HALOBETASOL PROP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in OH cover HALOBETASOL PROP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:50 /30Days |
Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in OH 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) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:50 /30Days |
HALOPERIDOL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HALOPERIDOL 5 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HALOPERIDOL LAC 2 MG/ML CONC ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL LAC 2 MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HALOPERIDOL LAC 5 MG/ML SYRING ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL LAC 5 MG/ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HALOPERIDOL LAC 5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HALOPERIDOL LAC 5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HARVONI 90-400 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HARVONI 90-400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HAVRIX 1,440 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in OH cover HAVRIX 1,440 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HAVRIX 720 UNITS/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HAVRIX 720 UNITS/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in OH cover HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HAVRIX HEPATITIS A VACCINE INJECTION ![Compare how all Medicare Part D PDP plans in OH cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HEPARIN 30,000 UNIT/30 ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HEPARIN 30,000 UNIT/30 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HEPARIN SOD 5,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HEPARIN SOD 5,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OH cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in OH cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HEPATAMINE INJECTION 8% ![Compare how all Medicare Part D PDP plans in OH cover HEPATAMINE INJECTION 8%.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | 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 OH 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) |
3 |
Preferred Brand |
$47.00 | $136.00 | P |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in OH cover HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P |
HETLIOZ 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover HETLIOZ 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HIBERIX VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in OH cover HIBERIX VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HUMIRA 10 MG/0.1 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 10 MG/0.1 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMIRA 10 MG/0.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 10 MG/0.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | 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 OH 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 |
28% | N/A | P Q:6 /28Days |
HUMIRA 20 MG/0.2 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 20 MG/0.2 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:2 /28Days |
HUMIRA 40 MG/0.4 ML PEN IJ KIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 40 MG/0.4 ML PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:6 /28Days |
HUMIRA 40 MG/0.4 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 40 MG/0.4 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:6 /28Days |
HUMIRA 40 MG/0.8 ML PEN ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA 40 MG/0.8 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P Q:6 /28Days |
HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMIRA PEN PSORIASIS-UVEITIS ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA PEN PSORIASIS-UVEITIS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA(CF) PEN CRHN-UC-HS 80MG PEN IJ KIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA(CF) PEN CRHN-UC-HS 80MG PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMIRA(CF) PEN PS-UV-AHS 80-40 PEN IJ KIT ![Compare how all Medicare Part D PDP plans in OH cover HUMIRA(CF) PEN PS-UV-AHS 80-40 PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HUMULIN R 500 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in OH cover HUMULIN R 500 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | None |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in OH cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
28% | N/A | P |
HYDRALAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDRALAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDRALAZINE 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDRALAZINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDRALAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDRALAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDRALAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDRALAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
Hydrochlorothiazide 12.5 MG Oral Capsule ![Compare how all Medicare Part D PDP plans in OH cover Hydrochlorothiazide 12.5 MG Oral Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCHLOROTHIAZIDE 12.5 MG TB ![Compare how all Medicare Part D PDP plans in OH cover HYDROCHLOROTHIAZIDE 12.5 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCHLOROTHIAZIDE 25 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover HYDROCHLOROTHIAZIDE 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCHLOROTHIAZIDE 50 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover HYDROCHLOROTHIAZIDE 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCODON-ACETAMINOPH 7.5-325 ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODON-ACETAMINOPH 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
HYDROCODON-ACETAMINOPHEN 5-325 ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODON-ACETAMINOPHEN 5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OH cover Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OH cover Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in OH 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 |
$47.00 | $136.00 | Q:180 /30Days |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in OH 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 |
$47.00 | $136.00 | Q:150 /30Days |
HYDROCODONE-ACETAMIN 10-325 MG Tablet [Norco] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODONE-ACETAMIN 10-325 MG Tablet [Norco].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
HYDROCODONE-ACETAMIN 7.5-325/15 Solution [Hycet] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODONE-ACETAMIN 7.5-325/15 Solution [Hycet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:5550 /30Days |
HYDROCODONE-IBUPROFEN 10-200 ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODONE-IBUPROFEN 10-200.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:150 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCODONE-IBUPROFEN 5-200 MG ![Compare how all Medicare Part D PDP plans in OH cover HYDROCODONE-IBUPROFEN 5-200 MG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:150 /30Days |
HYDROCORTISONE 0.1% SOLN ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 0.1% SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
HYDROCORTISONE 1% CREAM ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | None |
HYDROCORTISONE 1% OINTMENT ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
HYDROCORTISONE 10 MG TABLET [Hydrocortone] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 10 MG TABLET [Hydrocortone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort] ![Compare how all Medicare Part D PDP plans in OH 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 | $0.00 | None |
HYDROCORTISONE 100 MG/60 ML ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 100 MG/60 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDROCORTISONE 2.5% CREAM ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
HYDROCORTISONE 2.5% LOTION ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 2.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDROCORTISONE 2.5% OINTMENT ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 2.5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$2.00 | $0.00 | Q:30 /30Days |
HYDROCORTISONE 20 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 20 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE 5 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE 5 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HYDROCORTISONE BUTY 0.1% CREAM ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE BUTY 0.1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:45 /30Days |
HYDROCORTISONE BUTYR 0.1% LOTION [Locoid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE BUTYR 0.1% LOTION [Locoid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:118 /30Days |
HYDROCORTISONE BUTYR 0.1% OINT ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE BUTYR 0.1% OINT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:45 /30Days |
HYDROCORTISONE VAL 0.2% CREAM ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE VAL 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
HYDROCORTISONE VAL 0.2% OINTMT ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE VAL 0.2% OINTMT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:60 /30Days |
HYDROCORTISONE-ACETIC ACID SOLN ![Compare how all Medicare Part D PDP plans in OH cover HYDROCORTISONE-ACETIC ACID SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | None |
HYDROMORPHONE 1 MG/ML SOLUTION [Dilaudid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 1 MG/ML SOLUTION [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | Q:2400 /30Days |
HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 10 MG/ML VIAL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROMORPHONE 2 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 2 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
HYDROMORPHONE 2 MG/ML ISECURE Syringe [Simplist Dilaudid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 2 MG/ML ISECURE Syringe [Simplist Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROMORPHONE 4 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 4 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
HYDROMORPHONE 50 MG/5 ML VIAL [Dilaudid-HP] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 50 MG/5 ML VIAL [Dilaudid-HP].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROMORPHONE 8 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in OH cover HYDROMORPHONE 8 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | Q:180 /30Days |
HYDROXYCHLOROQUINE 200 MG TAB ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYCHLOROQUINE 200 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | None |
HYDROXYUREA 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYUREA 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$5.00 | $10.00 | None |
HYDROXYZINE 10 MG/5 ML SOLN ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE 10 MG/5 ML SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROXYZINE HCL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE HCL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROXYZINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROXYZINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROXYZINE PAM 100MG CAPSULE ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE PAM 100MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYDROXYZINE PAM 25 MG CAP ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE PAM 25 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROXYZINE PAM 50 MG CAP ![Compare how all Medicare Part D PDP plans in OH cover HYDROXYZINE PAM 50 MG CAP.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$100.00 | $300.00 | P |
HYSINGLA ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |
HYSINGLA ER 80 MG TABLET ![Compare how all Medicare Part D PDP plans in OH cover HYSINGLA ER 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$47.00 | $136.00 | P Q:30 /30Days |