Medicare Part D coverage · hydralazine hydrochloride · RxCUI 905377
hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet
Per the CMS 2026 Part D formulary file, hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet is covered by 3,363 Medicare Part D plans (66.6% of enrollable products), averaging Tier 2.9, with prior authorization required on 0% of covering formularies.
- 66.6%
- Plan coverage
- 3,363
- Plans covering
- T2.9
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet
Per the CMS 2026 Part D formulary file, hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet (RxNorm concept RXCUI 905377, generic name hydralazine hydrochloride) appears on 95 distinct formulary files spanning 3,363 Medicare Part D plan offerings - 66.6% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 6, with a cross-plan average of Tier 2.9.
Real-world access to hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 44.2% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 1,411,222 Part D beneficiaries filled hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $110,601,500 and an average per-beneficiary annual cost of $78.37. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 95
- Plans covering
- 3,363
- Coverage rate
- 66.6%
- Tier range
- Tier 1 – Tier 6
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 44.2% of formularies
2023 Medicare Spending
- Beneficiaries
- 1,411,222
- Total spending
- $110,601,500
- Avg per beneficiary
- $78.37
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet
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 |
| 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 |
| Mass General Brigham SCO (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Mass General Brigham One Care (HMO D-SNP) | Mass General Brigham Health Plan, Inc | T1 | No | $0 | MA |
| Leon MediExtra (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediDual (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMore (HMO) | Leon Health, Inc. | T1 | No | $0 | FL |
| Leon MediMax (HMO D-SNP) | Leon Health, Inc. | T1 | No | $0 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Florida, Inc. | T1 | No | $4.80 | FL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Michigan, Inc. | T1 | No | $8.80 | MI |
Show the next 30 plans
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF Illinois, Inc. | T1 | No | $15.20 | IL |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Arizona | T1 | No | $17.00 | AZ |
| WellSense Added Value (HMO) | Boston Medical Center Health Plan, Inc. | T1 | No | $21.70 | NH |
| 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 |
| Longevity Health Plan (PPO I-SNP) | Longevity Health Plan OF NEW Jersey Insurance Comp | T1 | No | $40.00 | NJ |
| VNS Health EasyCare Plus (HMO D-SNP) | VNS Choice | T1 | No | $51.60 | NY |
| ElderServe Star (HMO I-SNP) | Elderserve Health, Inc. | T1 | No | $58.80 | NY |
| Longevity Health Plan (HMO I-SNP) | Longevity Health Plan OF NEW York, Inc. | T1 | No | $58.80 | NY |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediMax (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plan (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun HealthAdvantage Plus (HMO) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun VitalCare (HMO C-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Full Dual Plus (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| HealthSun MediSun Full Dual Extra (HMO D-SNP) | Healthsun Health Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Complete (HMO D-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply Level (HMO C-SNP) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
| Simply More (HMO) | Simply Healthcare Plans, Inc. | T2 | No | $0 | FL |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet covered by Medicare Part D?
Yes, hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet is covered by 3,363 Medicare Part D plans (66.6% of all Part D formularies).
What tier is hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet on Medicare Part D plans?
hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet averages Tier 2.9 across Part D plans, ranging from Tier 1 to Tier 6.
Does hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet. Step therapy: 0%. Quantity limits: 44.2%.
How much does Medicare spend on hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet?
In 2023, total Medicare Part D spending on hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet was $110,601,500, covering 1,411,222 beneficiaries. The average spend per beneficiary was $78.37.
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
- atazanavir 150 MG Oral Capsule T2.9
- efavirenz 600 MG / emtricitabine 200 MG / tenofovir disoproxil fumarate 300 MG Oral Tablet T2.9
- lopinavir 100 MG / ritonavir 25 MG Oral Tablet T2.9
- lurasidone hydrochloride 120 MG Oral Tablet T2.9
- molindone hydrochloride 10 MG Oral Tablet T2.9
- mycophenolic acid 180 MG Delayed Release Oral Tablet T2.9
Similar prior-authorization rate
- metronidazole 10 MG/ML Topical Cream [Noritate] 0% PA
- 24 HR minocycline 40 MG Extended Release Oral Capsule [Emrosi] 0% PA
- buspirone hydrochloride 10 MG Oral Capsule [Bucapsol] 0% PA
- diflunisal 375 MG Oral Tablet [Dolobid] 0% PA
- hydrocortisone 1 MG/ML Oral Solution [Khindivi] 0% PA
- indomethacin 50 MG Rectal Suppository [Indocin] 0% PA