2019 Medicare Part D Plan Formulary Information |
Aspire Health Advantage (HMO) (H8764-001-0)
Benefit Details
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The Aspire Health Advantage (HMO) (H8764-001-0) Formulary Drugs Starting with the Letter H in Monterey County, CA: CMS MA Region 24 which includes: CA Plan Monthly Premium: $129.00 Deductible: $150 |
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 |
HAILEY 24 FE 1 MG-20 MCG TABLET [Tarina Fe 1/20] ![Compare how all Medicare Part D PDP plans in CA 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 |
$8.00 | $16.00 | None |
HALOBETASOL PROP 0.05% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HALOBETASOL PROP 0.05% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA cover Halobetasol Propionate 0.5mg/g 1 TUBE per CARTON / 50 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
Halog 1mg/g 60 g in 1 TUBE ![Compare how all Medicare Part D PDP plans in CA cover Halog 1mg/g 60 g in 1 TUBE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG] ![Compare how all Medicare Part D PDP plans in CA cover HALOG OINTMENT 1mg/g 60 g in 1 TUBE [HALOG].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HALOPERIDOL 0.5 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 0.5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL 1 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 1 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL 10 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL 20MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 20MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL 2MG TABLET (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL 2MG TABLET (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | 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 CA cover HALOPERIDOL 5 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HALOPERIDOL DEC 100 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL DEC 100 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HALOPERIDOL DEC 50MG 10 X 1ML PKG ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL DEC 50MG 10 X 1ML PKG.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HALOPERIDOL LAC 2 MG/ML CONC ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL LAC 2 MG/ML CONC.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL LAC 5 MG/ML SYRING ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL LAC 5 MG/ML SYRING.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HALOPERIDOL LAC 5 MG/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HALOPERIDOL LAC 5 MG/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HARVONI 90-400 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HARVONI 90-400 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:28 /28Days |
HAVRIX 1,440 UNITS/ML SYRINGE ![Compare how all Medicare Part D PDP plans in CA cover HAVRIX 1,440 UNITS/ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HAVRIX 720 UNITS/0.5 ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HAVRIX 720 UNITS/0.5 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD ![Compare how all Medicare Part D PDP plans in CA cover HAVRIX HEPATITIS A VACCINE INACTIVATED INJECTION SOLUTION 1440UNITS 10 X 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | 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 CA cover HAVRIX HEPATITIS A VACCINE INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HEPARIN 30,000 UNIT/30 ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN 30,000 UNIT/30 ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HEPARIN SOD 5,000 UNIT/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SOD 5,000 UNIT/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HEPARIN SODIUM INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HEPARIN SODIUM INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | 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 CA 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 |
$95.00 | $190.00 | P |
HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD ![Compare how all Medicare Part D PDP plans in CA cover HEPATITIS B VACCINE RECOMBIANT ADULT FORMULATION INJECTION 10MCG 1ML VIALSD.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HETLIOZ 20 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HETLIOZ 20 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:30 /30Days |
HIBERIX VACCINE WITH DILUENT ![Compare how all Medicare Part D PDP plans in CA cover HIBERIX VACCINE WITH DILUENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | None |
HUMALOG 100 UNITS/ML CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG 100 UNITS/ML CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG 100 UNITS/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG 100 UNITS/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMALOG 200 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG 200 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG JR 100 UNIT/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG JR 100 UNIT/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG MIX 50/50 VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG MIX 50/50 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG MIX 75/25 VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG MIX 75/25 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG MIX KWIKPEN INJECTION ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG MIX KWIKPEN INJECTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMALOG MIX KWIKPEN INJECTION SUSPENSION ![Compare how all Medicare Part D PDP plans in CA cover HUMALOG MIX KWIKPEN INJECTION SUSPENSION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMATROPE 12MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 12MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P |
HUMATROPE 24MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 24MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P |
HUMATROPE 5 MG VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 5 MG VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P |
HUMATROPE 6MG CARTRIDGE ![Compare how all Medicare Part D PDP plans in CA cover HUMATROPE 6MG CARTRIDGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMIRA 10 MG/0.1 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 10 MG/0.1 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:6 /28Days |
HUMIRA 10 MG/0.2 ML SYRINGE ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 10 MG/0.2 ML SYRINGE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:6 /28Days |
Humira 2 KIT per CARTON / 1 KIT in 1 KIT ![Compare how all Medicare Part D PDP plans in CA cover Humira 2 KIT per CARTON / 1 KIT in 1 KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA 20 MG/0.2 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 20 MG/0.2 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA 40 MG/0.4 ML PEN IJ KIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 40 MG/0.4 ML PEN IJ KIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA 40 MG/0.4 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 40 MG/0.4 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA 40 MG/0.8 ML PEN ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA 40 MG/0.8 ML PEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PED CROHNS 80 MG/0.8 ML SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:3 /28Days |
HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEDIATR CROHN'S 80-40MG SYRINGEKIT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:2 /28Days |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA PEDIATRIC CROHN'S START ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEDIATRIC CROHN'S START.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HUMIRA PEN KIT 40MG-70% 1 PKGCOM ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEN KIT 40MG-70% 1 PKGCOM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA PEN PSORIASIS-UVEITIS ![Compare how all Medicare Part D PDP plans in CA cover HUMIRA PEN PSORIASIS-UVEITIS.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
5 |
Specialty Tier |
30% | 30% | P Q:8 /28Days |
HUMIRA(CF) PEN CRHN-UC-HS 80MG PEN IJ KIT ![Compare how all Medicare Part D PDP plans in CA 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 |
30% | 30% | P Q:3 /28Days |
HUMIRA(CF) PEN PS-UV-AHS 80-40 PEN IJ KIT ![Compare how all Medicare Part D PDP plans in CA 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 |
30% | 30% | P Q:3 /28Days |
HUMULIN 70/30 KWIKPEN ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN 70/30 KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMULIN 70/30 VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN 70/30 VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMULIN N 100 UNITS/ML KWIKPEN ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN N 100 UNITS/ML KWIKPEN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMULIN N 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN N 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMULIN R 100U/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN R 100U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HUMULIN R 500U/ML VIAL ![Compare how all Medicare Part D PDP plans in CA cover HUMULIN R 500U/ML VIAL.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYDRALAZINE 10 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 10 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | 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 CA cover HYDRALAZINE 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDRALAZINE 25 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDRALAZINE 50 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDRALAZINE 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
Hydrochlorothiazide 12.5 MG Oral Capsule ![Compare how all Medicare Part D PDP plans in CA cover Hydrochlorothiazide 12.5 MG Oral Capsule.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDROCHLOROTHIAZIDE 12.5 MG TB ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE 12.5 MG TB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDROCHLOROTHIAZIDE 25 MG TAB ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE 25 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDROCHLOROTHIAZIDE 50 MG TAB ![Compare how all Medicare Part D PDP plans in CA cover HYDROCHLOROTHIAZIDE 50 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | None |
HYDROCODON-ACETAMINOPH 7.5-325 ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODON-ACETAMINOPH 7.5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:360 /30Days |
HYDROCODON-ACETAMINOPHEN 5-325 ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODON-ACETAMINOPHEN 5-325.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:360 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA cover Hydrocodone Bitartrate and Acetaminophen 300; 10mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA cover Hydrocodone Bitartrate and Acetaminophen 300; 5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1 ![Compare how all Medicare Part D PDP plans in CA cover Hydrocodone Bitartrate and Acetaminophen 300; 7.5mg/1; mg/1.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT) ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE BITARTRATE AND IBUPROFEN TABLET 7.5-200MG (100 CT).](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:480 /30Days |
HYDROCODONE-ACETAMIN 10-325 MG Tablet [Norco] ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE-ACETAMIN 10-325 MG Tablet [Norco].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:360 /30Days |
HYDROCODONE-ACETAMIN 7.5-325/15 Solution [Hycet] ![Compare how all Medicare Part D PDP plans in CA cover HYDROCODONE-ACETAMIN 7.5-325/15 Solution [Hycet].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:3600 /30Days |
HYDROCORTISONE 1% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 1% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 1% OINTMENT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 1% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 10 MG TABLET [Hydrocortone] ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 10 MG TABLET [Hydrocortone].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort] ![Compare how all Medicare Part D PDP plans in CA cover Hydrocortisone 10 MG/ML Topical Cream [Ala-Cort].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 100 MG/60 ML ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 100 MG/60 ML.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 2.5% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 2.5% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 2.5% LOTION ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 2.5% LOTION.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROCORTISONE 2.5% OINTMENT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 2.5% OINTMENT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 20 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 20 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE 5 MG TABLET [Cortef] ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE 5 MG TABLET [Cortef].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE VAL 0.2% CREAM ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE VAL 0.2% CREAM.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE VAL 0.2% OINTMT ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE VAL 0.2% OINTMT.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROCORTISONE-ACETIC ACID SOLN ![Compare how all Medicare Part D PDP plans in CA cover HYDROCORTISONE-ACETIC ACID SOLN.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROMORPHONE 2 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE 2 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
HYDROMORPHONE 4 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE 4 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
HYDROMORPHONE 8 MG TABLET [Dilaudid] ![Compare how all Medicare Part D PDP plans in CA cover HYDROMORPHONE 8 MG TABLET [Dilaudid].](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | Q:120 /30Days |
HYDROXYCHLOROQUINE 200 MG TAB ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYCHLOROQUINE 200 MG TAB.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
HYDROXYUREA 500 MG CAPSULE ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYUREA 500 MG CAPSULE.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
2* |
Generic |
$8.00 | $16.00 | None |
Drug Name |
Tier Nbr. |
Tier Description |
30-Day Preferred Pharm |
90-Day Mail Order |
Drug Usage Mgmt |
HYDROXYZINE HCL 25 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE HCL 25 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
1* |
Preferred Generic |
$4.00 | $8.00 | P |
HYDROXYZINE HCL 50 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYDROXYZINE HCL 50 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
4 |
Non-Preferred Drug |
$95.00 | $190.00 | P |
HYSINGLA ER 100 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 100 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 120 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 120 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 20 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 20 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 30 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 30 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 40 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 40 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 60 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 60 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |
HYSINGLA ER 80 MG TABLET ![Compare how all Medicare Part D PDP plans in CA cover HYSINGLA ER 80 MG TABLET.](https://q1medicare.com/pics/ContentPics/compare_partd_plans_by_drug.png) |
3 |
Preferred Brand |
$45.00 | $90.00 | Q:30 /30Days |