hydroxychloroquine sulfate 200 MG Oral Tablet
hydroxychloroquine sulfate
RxCUI: 979092
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 330 distinct formulary files spanning 5,067 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. 29.7% 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 $150,778,930 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 200 MG Oral Tablet today.
Coverage Details
- Formularies covering
- 330
- Plans covering
- 5,067
- 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
- 29.7% of formularies
2023 Medicare Spending
- Beneficiaries
- 583,911
- Total spending
- $150,778,930
- Avg per beneficiary
- $258.22
Tier Distribution Across Plans
Standalone Drug Plans (PDP) Covering hydroxychloroquine sulfate 200 MG Oral Tablet
5 standalone prescription drug plans include this drug.
| Plan | Insurer | Tier | PA | ST | Premium | States |
|---|---|---|---|---|---|---|
| Anthem Full Dual Advantage (PPO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Dual Advantage (PPO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Kidney Care (HMO-POS C-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Full Dual Advantage Select (HMO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
| Anthem Dual Advantage (HMO D-SNP) | ANTHEM HEALTH PLANS, INC. | T1 | No | No | $0 | CT |
Medicare Advantage Plans (MA-PD) Covering hydroxychloroquine sulfate 200 MG Oral Tablet
95 Medicare Advantage plans with Part D drug coverage include this drug.
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 5,067 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: 29.7%.
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 $150,778,930, covering 583,911 beneficiaries. The average spend per beneficiary was $258.22.
Read our methodology - how this data is sourced, computed, and verified.