hydroxychloroquine sulfate 300 MG Oral Tablet
hydroxychloroquine sulfate
RxCUI: 2569283
What the CMS Formulary Data Shows for hydroxychloroquine sulfate 300 MG Oral Tablet
Per the CMS 2026 Part D formulary file, hydroxychloroquine sulfate 300 MG Oral Tablet (RxNorm concept RXCUI 2569283, generic name hydroxychloroquine sulfate) appears on 94 distinct formulary files spanning 1,364 Medicare Part D plan offerings - 26.9% 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 300 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 57.4% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 583,911 Part D beneficiaries filled hydroxychloroquine sulfate 300 MG Oral Tablet in 2023, with total plan-and-beneficiary spending of $150,778,930 and an average per-beneficiary annual cost of $258.22. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydroxychloroquine sulfate 300 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 94
- Plans covering
- 1,364
- Coverage rate
- 26.9%
- 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
- 57.4% of formularies
2023 Medicare Spending
- Beneficiaries
- 583,911
- Total spending
- $150,778,930
- Avg per beneficiary
- $258.22
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering hydroxychloroquine sulfate 300 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 |
| 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 |
| 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 |
| 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 |
| Platino Blindao (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| Platino Enlace (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| PLATINO ADVANCE (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| PLATINO PLUS (HMO D-SNP) | TRIPLE S ADVANTAGE, INC. | T1 | No | $0 | PR |
| DrFlex (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T1 | No | $1.10 | FL |
| DrPlus (HMO D-SNP) | DOCTORS HEALTHCARE PLANS, INC. | T1 | No | $4.80 | FL |
| 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 |
| Texas Independence Community Plan (HMO I-SNP) | TEXAS INDEPENDENCE HEALTH PLAN, INC. | T1 | No | $4.80 | TX |
Frequently Asked Questions
Is hydroxychloroquine sulfate 300 MG Oral Tablet covered by Medicare Part D?
Yes, hydroxychloroquine sulfate 300 MG Oral Tablet is covered by 1,364 Medicare Part D plans (26.9% of all Part D formularies).
What tier is hydroxychloroquine sulfate 300 MG Oral Tablet on Medicare Part D plans?
hydroxychloroquine sulfate 300 MG Oral Tablet averages Tier 1.8 across Part D plans, ranging from Tier 1 to Tier 4.
Does hydroxychloroquine sulfate 300 MG Oral Tablet require prior authorization?
0% of Part D formularies require prior authorization for hydroxychloroquine sulfate 300 MG Oral Tablet. Step therapy: 0%. Quantity limits: 57.4%.
How much does Medicare spend on hydroxychloroquine sulfate 300 MG Oral Tablet?
In 2023, total Medicare Part D spending on hydroxychloroquine sulfate 300 MG Oral Tablet was $150,778,930, covering 583,911 beneficiaries. The average spend per beneficiary was $258.22.
Read our methodology - how this data is sourced, computed, and verified.