Medicare Part D coverage · hydroxychloroquine sulfate · RxCUI 979092

hydroxychloroquine sulfate 200 MG Oral Tablet

Per the CMS 2026 Part D formulary file, hydroxychloroquine sulfate 200 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of enrollable products), averaging Tier 2, with prior authorization required on 0% of covering formularies.

100%
Plan coverage
5,052
Plans covering
T2
Avg tier
0%
Prior auth required

Verify with CMS →

Important: Drug coverage and costs vary by plan and location. Verify coverage directly with your Medicare plan before filling a prescription. This is informational data only and should not replace advice from your healthcare provider or pharmacist.

What the CMS Formulary Data Shows for hydroxychloroquine sulfate 200 MG Oral Tablet

Per the CMS 2026 Part D formulary file, hydroxychloroquine sulfate 200 MG Oral Tablet (RxNorm concept RXCUI 979092, generic name hydroxychloroquine sulfate) appears on 328 distinct formulary files spanning 5,052 Medicare Part D plan offerings - 100% of enrollable Part D products, near-universal placement. Tier placement ranges from Tier 1 to Tier 4, with a cross-plan average of Tier 2.

Real-world access to hydroxychloroquine sulfate 200 MG Oral Tablet depends on utilization management as much as tier placement: 0% of covering formularies require prior authorization. 0% require step therapy. 29.9% apply quantity limits.

Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 583,911 Part D beneficiaries filled hydroxychloroquine sulfate 200 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 200 MG Oral Tablet today.

Coverage Details

Formularies covering
328
Plans covering
5,052
Coverage rate
100%
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
29.9% of formularies

2023 Medicare Spending

Beneficiaries
583,911
Total spending
$150,719,372
Avg per beneficiary
$258.12

Tier Distribution Across Plans

100 plans
Tier 1, Preferred Generic

Medicare Advantage Plans (MA-PD) Covering hydroxychloroquine sulfate 200 MG Oral Tablet

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
Wellpoint Medicare Advantage (HMO-POS) Wellpoint West Virginia , Inc. T1 No $0 WV
Anthem Medicare Advantage 3 (HMO-POS) Healthkeepers, Inc. T1 No $0 VA
Anthem Medicare Advantage 3 (HMO-POS) Healthkeepers, Inc. T1 No $0 VA
Anthem Medicare Advantage 3 (HMO-POS) Healthkeepers, Inc. T1 No $0 VA
Wellpoint Medicare Advantage 2 (HMO-POS) Wellpoint Tennessee, Inc. T1 No $0 TN
Wellpoint Medicare Advantage 2 (HMO-POS) Wellpoint Tennessee, Inc. T1 No $0 TN
Wellpoint Medicare Advantage 2 (HMO-POS) Wellpoint Tennessee, Inc. T1 No $0 TN
Wellpoint Medicare Advantage 2 (HMO-POS) Wellpoint Tennessee, Inc. T1 No $0 TN
Anthem Medicare Advantage (HMO-POS) Blue Cross OF California T1 No $0 CA
Anthem Medicare Advantage (HMO-POS) Blue Cross OF California T1 No $0 CA
Anthem Medicare Advantage (HMO-POS) Blue Cross OF California T1 No $0 CA
Anthem Medicare Advantage (HMO-POS) Blue Cross OF California T1 No $0 CA
Anthem Full Dual Advantage (HMO D-SNP) Anthem Insurance Companies, Inc. T1 No $0 IN
Anthem I PathWays Dual Care Advantage (HMO D-SNP) Anthem Insurance Companies, Inc. T1 No $0 IN
Anthem I PathWays Dual Care Advantage NFLOC (HMO D-SNP) Anthem Insurance Companies, Inc. T1 No $0 IN
Wellpoint Full Dual Advantage (HMO-POS D-SNP) Wellpoint Iowa, Inc. T1 No $0 IA
Wellpoint Full Dual Advantage 2 (HMO-POS D-SNP) Wellpoint Iowa, Inc. T1 No $0 IA
Wellpoint Full Dual Advantage (HMO D-SNP) Wellpoint West Virginia , Inc. T1 No $0 WV
Show the next 30 plans
Wellpoint Full Dual Advantage (HMO D-SNP) Wellpoint Washington, Inc. T1 No $0 WA
Wellpoint Dual Advantage (HMO D-SNP) Wellpoint Washington, Inc. T1 No $0 WA
Healthy Blue Dual Advantage (HMO D-SNP) Community Care Health Plan OF Louisiana, Inc. T1 No $0 LA
Healthy Blue Dual Advantage 2 (HMO D-SNP) Community Care Health Plan OF Louisiana, Inc. T1 No $0 LA
Anthem Dual Advantage (PPO D-SNP) Anthem Insurance Companies, Inc. T1 No $0 VA
Wellpoint Medicare Advantage 2 (HMO-POS) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Kidney Care (HMO-POS C-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Dual Advantage 2 (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Kidney Care (HMO-POS C-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage Aligned (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage 2 (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage 2 (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Wellpoint Full Dual Advantage (HMO D-SNP) Wellpoint Texas, Inc. T1 No $0 TX
Anthem I MyCare Ohio Full Dual Advantage (HMO D-SNP) Community Insurance Company T1 No $0 OH
Anthem Full Dual Advantage (HMO D-SNP) Community Insurance Company T1 No $0 OH
Anthem Full Dual Advantage 2 (HMO D-SNP) Community Insurance Company T1 No $0 OH
Anthem Full Dual Advantage (PPO D-SNP) Anthem Health Plans, Inc. T1 No $0 CT
Anthem Dual Advantage (PPO D-SNP) Anthem Health Plans, Inc. T1 No $0 CT
Wellpoint Full Dual Advantage (HMO D-SNP) Wellpoint NEW Jersey, Inc. T1 No $0 NJ
Wellpoint Kidney Care (HMO-POS C-SNP) Wellpoint NEW Jersey, Inc. T1 No $0 NJ
Wellpoint Full Dual Advantage Secure (HMO-POS D-SNP) Wellpoint NEW Jersey, Inc. T1 No $0 NJ
Anthem Medicare Advantage (HMO-POS) Healthkeepers, Inc. T1 No $0 VA
Anthem Full Dual Advantage (HMO D-SNP) Healthkeepers, Inc. T1 No $0 MO
Anthem Medicare Advantage 2 (HMO-POS) Healthkeepers, Inc. T1 No $0 VA
Anthem Kidney Care (HMO-POS C-SNP) Healthkeepers, Inc. T1 No $0 VA
Anthem Medicare Advantage (HMO-POS) Healthkeepers, Inc. T1 No $0 MO
Anthem Medicare Advantage 4 (HMO-POS) Healthkeepers, Inc. T1 No $0 VA

Showing top 50 of 100 plans.

Frequently Asked Questions

Is hydroxychloroquine sulfate 200 MG Oral Tablet covered by Medicare Part D?

Yes, hydroxychloroquine sulfate 200 MG Oral Tablet is covered by 5,052 Medicare Part D plans (100% of all Part D formularies).

What tier is hydroxychloroquine sulfate 200 MG Oral Tablet on Medicare Part D plans?

hydroxychloroquine sulfate 200 MG Oral Tablet averages Tier 2 across Part D plans, ranging from Tier 1 to Tier 4.

Does hydroxychloroquine sulfate 200 MG Oral Tablet require prior authorization?

0% of Part D formularies require prior authorization for hydroxychloroquine sulfate 200 MG Oral Tablet. Step therapy: 0%. Quantity limits: 29.9%.

How much does Medicare spend on hydroxychloroquine sulfate 200 MG Oral Tablet?

In 2023, total Medicare Part D spending on hydroxychloroquine sulfate 200 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

Data sourced from the Centers for Medicare & Medicaid Services (CMS). See our methodology for details. Retrieved and formatted by PlainMedicare