Medicare Part D coverage · hydroxyzine pamoate · RxCUI 995232
hydroxyzine pamoate 100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, hydroxyzine pamoate 100 MG Oral Capsule is covered by 3,434 Medicare Part D plans (68% of enrollable products), averaging Tier 2.5, with prior authorization required on 32.1% of covering formularies.
- 68%
- Plan coverage
- 3,434
- Plans covering
- T2.5
- Avg tier
- 32.1%
- Prior auth required
What the CMS Formulary Data Shows for hydroxyzine pamoate 100 MG Oral Capsule
Per the CMS 2026 Part D formulary file, hydroxyzine pamoate 100 MG Oral Capsule (RxNorm concept RXCUI 995232, generic name hydroxyzine pamoate) appears on 156 distinct formulary files spanning 3,434 Medicare Part D plan offerings - 68% 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 2.5.
Real-world access to hydroxyzine pamoate 100 MG Oral Capsule depends on utilization management as much as tier placement: 32.1% of covering formularies require prior authorization. 0% require step therapy. 0% apply quantity limits.
Historical spending context from the CMS Medicare Part D Drug Spending Dashboard shows 419,149 Part D beneficiaries filled hydroxyzine pamoate 100 MG Oral Capsule in 2023, with total plan-and-beneficiary spending of $20,653,747 and an average per-beneficiary annual cost of $49.28. The plan-by-plan detail below lists exactly which PDP and MA-PD contracts carry hydroxyzine pamoate 100 MG Oral Capsule today.
Coverage Details
- Formularies covering
- 156
- Plans covering
- 3,434
- Coverage rate
- 68%
- Tier range
- Tier 1 – Tier 4
- Average tier
- Tier 2, Generic
Restrictions
- Prior authorization required
- 32.1% of formularies
- Step therapy required
- 0% of formularies
- Quantity limits
- 0% of formularies
2023 Medicare Spending
- Beneficiaries
- 419,149
- Total spending
- $20,653,747
- Avg per beneficiary
- $49.28
Tier Distribution Across Plans
Medicare Advantage Plans (MA-PD) Covering hydroxyzine pamoate 100 MG Oral Capsule
100 Medicare Advantage plans with Part D drug coverage include this drug.
| Plan | Insurer | Tier | PA | Premium | States |
|---|---|---|---|---|---|
| CareAdvantage (HMO D-SNP) | SAN Mateo Health Commission | T1 | No | $0 | CA |
| DrMax (HMO) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrExtraCare (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrSelect (HMO) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrSelect-CFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrPlatinum-CFL (HMO D-SNP) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrTotalCare-CFL (HMO C-SNP) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| DrElite-SFL (HMO) | Doctors Healthcare Plans, Inc. | T1 | Yes | $0 | FL |
| Horizon NJ TotalCare (HMO D-SNP) | Horizon Healthcare OF NEW Jersey, Inc. | T1 | Yes | $0 | NJ |
| NaviCare (HMO D-SNP) | Fallon Community Health Plan | T1 | No | $0 | MA |
| Hamaspik Medicare Choice (HMO D-SNP) | Hamaspik, Inc. | T1 | Yes | $0 | NY |
| SeniorCare Complete (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| AbilityCare (HMO D-SNP) | South Country Health Alliance | T1 | Yes | $0 | MN |
| Alameda Alliance Wellness (HMO D-SNP) | Alameda Alliance FOR Health | T1 | Yes | $0 | CA |
| PHP (HMO C-snp) | Aids Healthcare Foundation | T1 | No | $0 | CA |
| Astiva Health Savings Plan (HMO) | Astiva Health, Inc. | T1 | No | $0 | CA |
| Astiva Health C-SNP Deluxe (HMO C-SNP) | Astiva Health, Inc. | T1 | No | $0 | CA |
| Astiva Health Savings Plan - NorCal (HMO) | Astiva Health, Inc. | T1 | No | $0 | CA |
| Astiva Health Premier Plan - NorCal (HMO) | Astiva Health, Inc. | T1 | No | $0 | CA |
| Astiva Health Premier Plan (HMO) | Astiva Health, Inc. | T1 | No | $0 | CA |
Show the next 30 plans
| ATRIO Prime Rx (HMO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Choice Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Choice Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Prime Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Prime Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Prime Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Choice Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Choice Rx (PPO) | Atrio Health Plans | T1 | No | $0 | OR |
| ATRIO Support Rx (PPO C-SNP) | Atrio Health Plans | T1 | No | $0 | OR |
| TotalCare (HMO D-SNP) | Santa Cruz Monterey Merced SAN Benito Mariposa Managed Medic | T1 | No | $0 | CA |
| Elevate Medicare Choice (HMO D-SNP) | Denver Health Medical Plan, Inc. | T1 | No | $0 | CO |
| McLaren Medicare Inspire (HMO) | Mclaren Health Plan, Inc. | T1 | No | $0 | MI |
| McLaren Medicare Inspire Select (HMO) | Mclaren Health Plan, Inc. | T1 | No | $0 | MI |
| 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 |
| CommuniCare Advantage CSNP (HMO C-SNP) | OH CHS SNP Inc. | T1 | No | $0 | MD, OH |
| 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 |
Showing top 50 of 100 plans.
Frequently Asked Questions
Is hydroxyzine pamoate 100 MG Oral Capsule covered by Medicare Part D?
Yes, hydroxyzine pamoate 100 MG Oral Capsule is covered by 3,434 Medicare Part D plans (68% of all Part D formularies).
What tier is hydroxyzine pamoate 100 MG Oral Capsule on Medicare Part D plans?
hydroxyzine pamoate 100 MG Oral Capsule averages Tier 2.5 across Part D plans, ranging from Tier 1 to Tier 4.
Does hydroxyzine pamoate 100 MG Oral Capsule require prior authorization?
32.1% of Part D formularies require prior authorization for hydroxyzine pamoate 100 MG Oral Capsule. Step therapy: 0%. Quantity limits: 0%.
How much does Medicare spend on hydroxyzine pamoate 100 MG Oral Capsule?
In 2023, total Medicare Part D spending on hydroxyzine pamoate 100 MG Oral Capsule was $20,653,747, covering 419,149 beneficiaries. The average spend per beneficiary was $49.28.
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
- paroxetine hydrochloride 10 MG Oral Tablet 32% PA
- {14 (cenobamate 100 MG Oral Tablet [Xcopri]) / 14 (cenobamate 50 MG Oral Tablet [Xcopri]) } Pack [Xcopri Titration Pack - 50 MG (14), 100 MG (14) 28 Count] 32.3% PA
- {28 (cenobamate 150 MG Oral Tablet [Xcopri]) / 28 (cenobamate 200 MG Oral Tablet) } Pack [Xcopri 350 MG Maintenance Pack] 32.3% PA
- cenobamate 50 MG Oral Tablet [Xcopri] 32.3% PA
- cenobamate 25 MG Oral Tablet [Xcopri] 32.3% PA
- {14 (cenobamate 12.5 MG Oral Tablet [Xcopri]) / 14 (cenobamate 25 MG Oral Tablet [Xcopri]) } Pack [Xcopri Titration Pack - 12.5 MG (14), 25 MG (14) 28 Count] 32.3% PA