Medicare Part D coverage · 5 · RxCUI 1724340
5 ML hydromorphone hydrochloride 10 MG/ML Injection
Per the CMS 2026 Part D formulary file, 5 ML hydromorphone hydrochloride 10 MG/ML Injection is covered by 1,426 Medicare Part D plans (28.2% of enrollable products), averaging Tier 3.1, with prior authorization required on 30.5% of covering formularies.
- 28.2%
- Plan coverage
- 1,426
- Plans covering
- T3.1
- Avg tier
- 30.5%
- Prior auth required
What the CMS Formulary Data Shows for 5 ML hydromorphone hydrochloride 10 MG/ML Injection
Per the CMS 2026 Part D formulary file, 5 ML hydromorphone hydrochloride 10 MG/ML Injection (RxNorm concept RXCUI 1724340, generic name 5) appears on 118 distinct formulary files spanning 1,426 Medicare Part D plan offerings - 28.2% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.1.
Real-world access to 5 ML hydromorphone hydrochloride 10 MG/ML Injection depends on utilization management as much as tier placement: 30.5% of covering formularies require prior authorization. 0% require step therapy. 0.8% apply quantity limits.
Medicare Part D spending dashboard figures are not published for this drug. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry 5 ML hydromorphone hydrochloride 10 MG/ML Injection today.
Coverage Details
- Formularies covering
- 118
- Plans covering
- 1,426
- Coverage rate
- 28.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 30.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0.8% of formularies
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering 5 ML hydromorphone hydrochloride 10 MG/ML Injection
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| ElderServe MAP (HMO D-SNP) | Elderserve Health, Inc. | T1 | No | $0 | NY |
| Cooperative Advantage (HMO D-SNP) | Group Health Cooperative OF EAU Claire | T1 | No | $0 | WI |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $0 | NJ |
| Upper Peninsula Health Plan MI Coordinated Health (HMO D-SNP) | Upper Peninsula Health Plan, LLC | T1 | No | $0 | MI |
| CareSource Dual Advantage (HMO D-SNP) | Caresource Georgia Co. | T1 | No | $0 | GA |
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | Yes | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | Yes | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | Yes | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | No | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | No | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $0 | PA |
| Provider Partners North Carolina Community Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $0 | NC |
Show the next 30 plans
| Provider Partners Indiana Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $0 | IN |
| Provider Partners Missouri Community Plan (HMO I-SNP) | Provider Partners Health Plan OF Missouri, Inc. | T1 | No | $0 | MO |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | Yes | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $0 | DE |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Hcsc Insurance Services Company | T1 | Yes | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Provider Partners Texas Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Texas, Inc. | T1 | No | $4.80 | TX |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | GHS Insurance Company | T1 | Yes | $5.00 | OK |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $13.10 | PA |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Provider Partners Illinois Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Illinois | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| Highmark Wholecare Medicare Assured Ruby (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | Yes | $17.60 | PA |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
| Highmark Health Options Duals Select (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | Yes | $31.20 | DE |
| Provider Partners Pennsylvania Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Provider Partners Pennsylvania Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Pennsylvania, Inc | T1 | No | $32.70 | PA |
| Hamaspik Medicare Select (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $34.50 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Colorado, Inc. | T1 | No | $35.20 | CO |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF North Carolina, Inc. | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners North Carolina Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF North Carolina | T1 | No | $36.20 | NC |
| Provider Partners Indiana Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Indiana Essential Plan (HMO I-SNP) | Provider Partners Health Plan OF Indiana | T1 | No | $38.40 | IN |
| Provider Partners Kentucky Advantage Plan (HMO I-SNP) | Provider Partners Health Plan OF Kentucky | T1 | No | $38.40 | KY |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is 5 ML hydromorphone hydrochloride 10 MG/ML Injection covered by Medicare Part D?
Yes, 5 ML hydromorphone hydrochloride 10 MG/ML Injection is covered by 1,426 Medicare Part D plans (28.2% of all Part D formularies).
What tier is 5 ML hydromorphone hydrochloride 10 MG/ML Injection on Medicare Part D plans?
5 ML hydromorphone hydrochloride 10 MG/ML Injection averages Tier 3.1 across Part D plans, ranging from Tier 1 to Tier 4.
Does 5 ML hydromorphone hydrochloride 10 MG/ML Injection require prior authorization?
30.5% of Part D formularies require prior authorization for 5 ML hydromorphone hydrochloride 10 MG/ML Injection. Step therapy: 0%. Quantity limits: 0.8%.
Read our methodology - how this data is sourced, computed, and verified.
Nationwide similar Part D drugs
Data-derived peers across the CMS Part D formulary extract: nearest average tier placement and nearest prior-authorization rate. Not therapeutic alternatives or same-generic strengths.
Closest average formulary tier
- metronidazole 7.5 MG/ML Topical Lotion T3.1
- rifaximin 200 MG Oral Tablet [XIFAXAN] T3.1
- ospemifene 60 MG Oral Tablet [Osphena] T3.1
- 24 HR pramipexole dihydrochloride 0.75 MG Extended Release Oral Tablet T3.1
- levonorgestrel 0.000729 MG/HR Intrauterine System [Kyleena] T3.1
- cyclosporine, modified 25 MG Oral Capsule [Neoral] T3.1
Similar prior-authorization rate
- zolpidem tartrate 12.5 MG Extended Release Oral Tablet 30.4% PA
- amitriptyline hydrochloride 10 MG Oral Tablet 30.8% PA
- amitriptyline hydrochloride 25 MG Oral Tablet 30.8% PA
- amitriptyline hydrochloride 100 MG Oral Tablet 30.8% PA
- calcium acetate 667 MG Oral Capsule 30.2% PA
- 24 HR lacosamide 100 MG Extended Release Oral Capsule [Motpoly] 30.8% PA