hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil]
hydralazine hydrochloride
RxCUI: 905379
What the CMS Formulary Data Shows for hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil]
Per the CMS 2026 Part D formulary file, hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] (RxNorm concept RXCUI 905379, generic name hydralazine hydrochloride) appears on 4 distinct formulary files spanning 26 Medicare Part D plan offerings - 0.5% of enrollable Part D products, selective placement; verify formulary inclusion before enrolling. Tier placement ranges from Tier 3 to Tier 3, with a cross-plan average of Tier 3.
Real-world access to hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 0% 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 [Bidil] 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 [Bidil] today.
Coverage Details
- Formularies covering
- 4
- Plans covering
- 26
- Coverage rate
- 0.5%
- Tier range
- Tier 3, Preferred Brand
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% 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 [Bidil]
26 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T3 | No | $0 | FL |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T3 | No | $0 | FL |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Plus (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Beyond (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Giveback (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Beyond (HMO-POS) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Dual (HMO D-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T3 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST | T3 | No | $0 | NV |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T3 | No | $0 | FL |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Diabetes and Heart Care Plus (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Diabetes and Heart Giveback (HMO C-SNP) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $0 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T3 | No | $4.20 | NV |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF FLORIDA INC | T3 | No | $4.80 | FL |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST OF TEXAS | T3 | No | $4.80 | TX |
| Prominence Extra Help (HMO) | PROMINENCE HEALTHFIRST | T3 | No | $9.50 | NV |
Frequently Asked Questions
Is hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] covered by Medicare Part D?
Yes, hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] is covered by 26 Medicare Part D plans (0.5% of all Part D formularies).
What tier is hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] on Medicare Part D plans?
hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] averages Tier 3 across Part D plans, ranging from Tier 3 to Tier 3.
Does hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] require prior authorization?
0% of Part D formularies require prior authorization for hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil]. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil]?
In 2023, total Medicare Part D spending on hydralazine hydrochloride 37.5 MG / isosorbide dinitrate 20 MG Oral Tablet [Bidil] 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.