Medicare Part D coverage · hydromorphone hydrochloride · RxCUI 897657
hydromorphone hydrochloride 1 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, hydromorphone hydrochloride 1 MG/ML Oral Solution is covered by 2,687 Medicare Part D plans (53.2% of enrollable products), averaging Tier 3, with prior authorization required on 1.5% of covering formularies.
- 53.2%
- Plan coverage
- 2,687
- Plans covering
- T3
- Avg tier
- 1.5%
- Prior auth required
What the CMS Formulary Data Shows for hydromorphone hydrochloride 1 MG/ML Oral Solution
Per the CMS 2026 Part D formulary file, hydromorphone hydrochloride 1 MG/ML Oral Solution (RxNorm concept RXCUI 897657, generic name hydromorphone hydrochloride) appears on 194 distinct formulary files spanning 2,687 Medicare Part D plan offerings - 53.2% of enrollable Part D products, mid-range placement; shopping across contracts changes access. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 3.
Real-world access to hydromorphone hydrochloride 1 MG/ML Oral Solution depends on utilization management as much as tier placement: 1.5% of covering formularies require prior authorization. 0% require step therapy. 92.8% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 234,154 Part D beneficiaries filled hydromorphone hydrochloride 1 MG/ML Oral Solution in 2023, with total plan-and-beneficiary spending of $15,211,234 and an average per-beneficiary annual cost of $64.96. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydromorphone hydrochloride 1 MG/ML Oral Solution today.
Coverage Details
- Formularies covering
- 194
- Plans covering
- 2,687
- Coverage rate
- 53.2%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 3, Preferred Brand
Restrictions
- Prior authorization required
- 1.5% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 92.8% of formularies
2023 Medicare Spending
- Beneficiaries
- 234,154
- Total spending
- $15,211,234
- Avg per beneficiary
- $64.96
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering hydromorphone hydrochloride 1 MG/ML Oral Solution
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| Sentara Community Complete Select (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Sentara Community Complete (HMO D-SNP) | Sentara Health Plans | T1 | No | $0 | VA |
| Florida Complete Care-Duals VIP (HMO-POS D-SNP) | Hpmp OF Florida, Inc. | T1 | No | $0 | FL |
| 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 |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Mercy Care Advantage (HMO D-SNP) | Mercy Care | T1 | No | $0 | AZ |
| Elderplan Plus Long-Term Care (HMO-POS D-SNP) | Elderplan, Inc. | T1 | No | $0 | NY |
| Health Choice Pathway (HMO D-SNP) | Health Choice Arizona, Inc. | T1 | No | $0 | AZ |
| Healthfirst CompleteCare (HMO D-SNP) | Healthfirst Health Plan, Inc. | T1 | No | $0 | NY |
| IMCare Classic (HMO D-SNP) | Itasca Medical Care | T1 | No | $0 | MN |
| Johns Hopkins Advantage MD D-SNP (HMO D-SNP) | Hopkins Health Advantage, Inc. | T1 | No | $0 | MD |
| MetroPlus UltraCare (HMO D-SNP) | Metroplus Health Plan, Inc. | T1 | No | $0 | NY |
| 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 |
| Senior Whole Health SCO (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Senior Whole Health SCO NHC (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
| Molina One Care (HMO D-SNP) | Senior Whole Health, LLC | T1 | No | $0 | MA |
Show the next 30 plans
| HAP CareSource MI Coordinated Health (HMO D-SNP) | HAP Caresource | T1 | No | $0 | MI |
| Gold Coast Health Plan Total Care Advantage (HMO D-SNP) | Ventura County Medi-Cal Managed Care Commission | T1 | No | $0 | CA |
| Blue Cross Medicare Advantage Dual Care Plus (HMO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Blue Cross MA Dual Care Plus Preferred (PPO D-SNP) | Health Care Service Corporation | T1 | No | $0 | NM |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | No | $0 | NJ |
| SecureBlue (HMO D-SNP) | HMO Minnesota | T1 | No | $0 | MN |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $0 | NY |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| CCA One Care (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| CCA Senior Care Options (HMO D-SNP) | Commonwealth Care Alliance, Inc. | T1 | No | $0 | MA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Abilis Health Community (HMO I-SNP) | Signature Advantage, LLC | T1 | No | $0 | KY, TN |
| Arkansas Integrated Providers (AIP) Dual Advantage (HMO D-SNP) | Arkansas Superior Select, Inc. | T1 | No | $0 | AR |
| CalOptima Health OneCare Complete (HMO D-SNP) | Orange County Health Authority | T1 | No | $0 | CA |
| 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 |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | Gateway Health Plan, Inc. | T1 | No | $0 | PA |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Health Options West Virginia Inc. | T1 | No | $0 | WV |
| Highmark Health Options Duals (HMO D-SNP) | Highmark Bcbsd, Inc. | T1 | No | $0 | DE |
| Tufts Health One Care (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health One Care CW (HMO D-SNP) | Tufts Health Public Plans, Inc. | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Tufts Health Plan Senior Care Options CW (HMO D-SNP) | Tufts Associated Health Maintenance Organization | T1 | No | $0 | MA |
| Florida Complete Care (HMO I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| Florida Complete Care- In The Community (HMO-POS I-SNP) | Hpmp OF Florida, Inc. | T1 | No | $4.80 | FL |
| 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 | No | $4.80 | TX |
| Gold Dialysis & Kidney Complete (HMO-POS C-SNP) | Gold Kidney OF Florida Inc | T1 | No | $4.80 | FL |
| Texas Independence Health Plan, Inc. (HMO I-SNP) | Texas Independence Health Plan, Inc. | T1 | No | $4.80 | TX |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is hydromorphone hydrochloride 1 MG/ML Oral Solution covered by Medicare Part D?
Yes, hydromorphone hydrochloride 1 MG/ML Oral Solution is covered by 2,687 Medicare Part D plans (53.2% of all Part D formularies).
What tier is hydromorphone hydrochloride 1 MG/ML Oral Solution on Medicare Part D plans?
hydromorphone hydrochloride 1 MG/ML Oral Solution averages Tier 3 across Part D plans, ranging from Tier 1 to Tier 4.
Does hydromorphone hydrochloride 1 MG/ML Oral Solution require prior authorization?
1.5% of Part D formularies require prior authorization for hydromorphone hydrochloride 1 MG/ML Oral Solution. Step therapy: 0%. Quantity limits: 92.8%.
How much does Medicare spend on hydromorphone hydrochloride 1 MG/ML Oral Solution?
In 2023, total Medicare Part D spending on hydromorphone hydrochloride 1 MG/ML Oral Solution was $15,211,234, covering 234,154 beneficiaries. The average spend per beneficiary was $64.96.
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
- 120 ACTUAT albuterol 0.1 MG/ACTUAT / ipratropium bromide 0.02 MG/ACTUAT Inhalation Spray [Combivent] T3
- 24 HR paliperidone 3 MG Extended Release Oral Tablet T3
- naloxone hydrochloride 80 MG/ML Nasal Spray [Kloxxado] T3
- griseofulvin 250 MG Oral Tablet T3
- hydroxyurea 200 MG Oral Capsule [Droxia] T3
- methscopolamine bromide 2.5 MG Oral Tablet T3
Similar prior-authorization rate
- eslicarbazepine acetate 400 MG Oral Tablet [Aptiom] 1.5% PA
- eslicarbazepine acetate 200 MG Oral Tablet [Aptiom] 1.5% PA
- 0.5 ML varicella zoster virus glycoprotein E, recombinant 0.1 MG/ML Prefilled Syringe [Shingrix] 1.5% PA
- simvastatin 80 MG Oral Tablet 1.5% PA
- ribavirin 200 MG Oral Capsule 1.5% PA
- 1000 ML glucose 50 MG/ML / potassium chloride 0.02 MEQ/ML / sodium chloride 9 MG/ML Injection 1.5% PA