Ampicillin and Sulbactam Medicare Coverage in Hawaii
cover Ampicillin and Sulbactam
Medicare Plans Covering Ampicillin and Sulbactam in Hawaii
Sorted by lowest 30-day copay at a preferred pharmacy. Prices shown are estimates from CMS formulary data.
| Plan Name | Monthly Premium | Tier | 30-day Copay | Stars | Restrictions | Action |
|---|---|---|---|---|---|---|
| DEVOTED CHOICE GIVEBACK 005 HI (PPO) Lowest Copay | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Kaiser Permanente Dual Complete Oahu (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| Humana Gold Plus H0028-082 (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CORE 004 HI (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE GIVEBACK 005 HI (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Humana USAA Honor Giveback with Rx (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Kaiser Permanente Dual Complete Maui (HMO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| DEVOTED CORE 005 HI (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HMSA Akamai Advantage Standard (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Kaiser Permanente Senior Advantage Basic (HMO) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| AlohaCare Advantage Plus (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| HumanaChoice H5216-465 (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| UHC Dual Complete HI-Y1 (PPO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 008 HI (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 001 HI (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 004 HI (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HMSA Akamai Advantage Dual Care (PPO D-SNP) | $0.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE GIVEBACK 009 HI (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 002 HI (HMO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 004 HI (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC HI-0001 (PPO) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE PREMIUM 006 HI (PPO) | $8.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE PREMIUM 006 HI (PPO) | $8.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE PREMIUM 010 HI (PPO) | $9.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HMSA Akamai Advantage Complete (PPO) | $11.70/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Kaiser Permanente Senior Advantage Enhanced (HMO) | $13.70/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
| HumanaChoice H5216-313 (PPO) | $14.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC HI-0003 (PPO) | $29.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HMSA Akamai Advantage Complete Plus (PPO) | $31.80/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Kaiser Permanente Senior Advantage Maui (HMO) | $33.00/mo | Tier 2 - Generic | $0.00 | N/A | None | Details → |
Compare All Hawaii Plans for Ampicillin and Sulbactam
Enter your exact ZIP code to see plans available in your specific county, ranked by total annual cost.
Frequently Asked Questions
100% of Medicare Part D plans in Hawaii cover Ampicillin and Sulbactam. There are 30 plans available. Coverage and costs vary by specific plan.
Costs vary by plan. Compare plans to find the lowest cost option for you.
Based on current CMS data, DEVOTED CHOICE GIVEBACK 005 HI (PPO) offers one of the lowest copays for Ampicillin and Sulbactam in Hawaii. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Ampicillin and Sulbactam Coverage in Other States
Click any state to see the plans and costs available there.
Coverage data from CMS formulary files for plan year 2026. How we calculate costs • National coverage for Ampicillin and Sulbactam
Get Ampicillin and Sulbactam Delivered to Your Door
Compare prices and get discounts from trusted online pharmacies
DrugCovered may earn commissions from pharmacy purchases. Prices and availability vary. Always consult your doctor before starting or changing medications.