Hydroxyzine Pamoate Medicare Coverage in Pennsylvania
cover Hydroxyzine Pamoate
Medicare Plans Covering Hydroxyzine Pamoate in Pennsylvania
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 |
|---|---|---|---|---|---|---|
| HumanaChoice SNP-DE H7617-048 (PPO D-SNP) Lowest Copay | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE GIVEBACK 003 PA (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage from UHC PA-0002 (HMO-POS) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CORE 008 PA (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| UPMC for Life Complete Care (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| HumanaChoice Giveback H5525-085 (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-037 (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Special (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 015 PA (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE 007 PA (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Classic 360 Rx (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED GIVEBACK 009 PA (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Secure Rx (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Highmark Wholecare Medicare Assured Diamond (HMO D-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| Clover Health Choice (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Humana Gold Plus H6622-054 (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Complete (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Perennial Advantage Freedom (HMO) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| Aetna Community HealthChoices (HMO D-SNP) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Flex (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Geisinger Gold Classic Essential Rx (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Provider Partners Pennsylvania Community Plan (HMO I-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
| DEVOTED CHOICE GIVEBACK 008 PA (PPO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| AARP Medicare Advantage Essentials from UHC PA-5 (HMO-POS) | $0.00/mo | Tier 4 - Non-Preferred Drug | $0.00 | N/A | None | Details → |
| DEVOTED CORE 010 PA (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| DEVOTED CORE 023 PA (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Humana Gold Plus SNP-DE H6622-078 (HMO D-SNP) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Jefferson Health Plans Giveback (HMO) | $0.00/mo | Tier 3 - Preferred Brand | $0.00 | N/A | None | Details → |
| Perennial Advantage Premier (HMO I-SNP) | $0.00/mo | Tier 1 - Preferred Generic | $0.00 | N/A | None | Details → |
Compare All Pennsylvania Plans for Hydroxyzine Pamoate
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Frequently Asked Questions
100% of Medicare Part D plans in Pennsylvania cover Hydroxyzine Pamoate. 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, HumanaChoice SNP-DE H7617-048 (PPO D-SNP) offers one of the lowest copays for Hydroxyzine Pamoate in Pennsylvania. Enter your ZIP code to see all plans and compare total annual costs including premiums.
Hydroxyzine Pamoate Coverage in Other States
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Coverage data from CMS formulary files for plan year 2026. How we calculate costs • National coverage for Hydroxyzine Pamoate
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