Medicare Part D coverage · hydroxychloroquine sulfate · RxCUI 2569281
hydroxychloroquine sulfate 100 MG Oral Tablet
Per the CMS 2026 Part D formulary file, hydroxychloroquine sulfate 100 MG Oral Tablet is covered by 1,465 Medicare Part D plans (29% of enrollable products), averaging Tier 1.8, with prior authorization required on 0% of covering formularies.
- 29%
- Plan coverage
- 1,465
- Plans covering
- T1.8
- Avg tier
- 0%
- Prior auth required
What the CMS Formulary Data Shows for hydroxychloroquine sulfate 100 MG Oral Tablet
Per the CMS 2026 Part D formulary file, hydroxychloroquine sulfate 100 MG Oral Tablet (RxNorm concept RXCUI 2569281, generic name hydroxychloroquine sulfate) appears on 114 distinct formulary files spanning 1,465 Medicare Part D plan offerings - 29% 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 1.8.
Real-world access to hydroxychloroquine sulfate 100 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 46.5% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 583,911 Part D beneficiaries filled hydroxychloroquine sulfate 100 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $150,719,372 and an average per-beneficiary annual cost of $258.12. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydroxychloroquine sulfate 100 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 114
- Plans covering
- 1,465
- Coverage rate
- 29%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 0% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 46.5% of formularies
2023 Medicare Spending
- Beneficiaries
- 583,911
- Total spending
- $150,719,372
- Avg per beneficiary
- $258.12
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering hydroxychloroquine sulfate 100 MG Oral Tablet
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| DrMax (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrExtraCare (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrSelect (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrSelect-CFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| DrElite-SFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | No | $0 | FL |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | No | $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 |
| Troy Medicare (HMO) | Troy Health, Inc. | T1 | No | $0 | NC |
| Troy Medicare for Dual-eligible Beneficiaries (HMO D-SNP) | Troy Health, Inc. | T1 | No | $0 | NC |
| Contra Costa Health Care Plus (HMO D-SNP) | Contra Costa County Medical Service DBA Contra Costa Health | T1 | No | $0 | CA |
| Keystone First VIP Choice (HMO D-SNP) | Vista Health Plan, Inc. | T1 | No | $0 | PA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Vista Health Plan, Inc. | T1 | No | $0 | PA |
| First Choice VIP Care (HMO D-SNP) | Select Health OF South Carolina, Inc. | T1 | No | $0 | SC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T1 | No | $0 | DE |
| AmeriHealth Caritas VIP Care Choice (HMO D-SNP) | AmeriHealth Caritas VIP Next, Inc. | T1 | No | $0 | DE |
Show the next 30 plans
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Florida, Inc. | T1 | No | $0 | FL |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas Louisiana, Inc. | T1 | No | $0 | LA |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Caritas North Carolina, Inc. | T1 | No | $0 | NC |
| AmeriHealth Caritas VIP Care (HMO D-SNP) | Amerihealth Michigan, Inc. | T1 | No | $0 | MI |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| AllCare Advantage Redwood Rx (HMO D-SNP) | Allcare Health Plan, Inc. | T1 | No | $0 | OR |
| PrimeWest Senior Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| Prime Health Complete (HMO D-SNP) | Primewest Rural MN Health Care Access Initiative | T1 | No | $0 | MN |
| DualConnect (HMO D-SNP) | Santa Clara County Health Authority | T1 | No | $0 | CA |
| VNS Health Total (HMO D-SNP) | VNS Choice | T1 | No | $0 | NY |
| Alterwood Advantage Dual Secure (HMO D-SNP) | Alterwood Advantage, Inc. | T1 | No | $0 | MD |
| Generations Classic Rewards (HMO) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Classic Plus (HMO) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Chronic Care (HMO C-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Chronic Care Savings (HMO C-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Dual Support (HMO D-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Generations Dual Premier (HMO D-SNP) | Globalhealth, Inc. | T1 | No | $0 | OK |
| Nascentia Dual Advantage (HMO D-SNP) | Visiting Nurse Association OF Central NEW York | 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 |
| 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 |
| 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 |
| Community Care's Partnership Program (HMO D-SNP) | Community Care Health Plan, Inc. | T1 | No | $0 | WI |
| Óptimo Plus (PPO) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Contigo Plus (HMO C-SNP) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Brillante (HMO-POS) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
| Enlace Plus (HMO) | Triple S Advantage, Inc. | T1 | No | $0 | PR |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is hydroxychloroquine sulfate 100 MG Oral Tablet covered by Medicare Part D?
Yes, hydroxychloroquine sulfate 100 MG Oral Tablet is covered by 1,465 Medicare Part D plans (29% of all Part D formularies).
What tier is hydroxychloroquine sulfate 100 MG Oral Tablet on Medicare Part D plans?
hydroxychloroquine sulfate 100 MG Oral Tablet averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does hydroxychloroquine sulfate 100 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for hydroxychloroquine sulfate 100 MG Oral Tablet. Step therapy: 0%. Quantity limits: 46.5%.
How much does Medicare spend on hydroxychloroquine sulfate 100 MG Oral Tablet?
In 2023, total Medicare Part D spending on hydroxychloroquine sulfate 100 MG Oral Tablet was $150,719,372, covering 583,911 beneficiaries. The average spend per beneficiary was $258.12.
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
Similar prior-authorization rate
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