MedicarePartD.guide

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2026 Humana Premier Rx Plan (PDP) formulary (drug list)

Contract S5884, plan 180 · Alaska · 3,076 drugs on file · formulary ID 00026402. Each drug links to its cost in every CMS PDP Region 34 plan.

Hide drugs on tiers

19 drugs starting with U.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
UBRELVY 100 mg TabletUbrogepant3Preferred Brand$45.00$125.00
  • PA
  • QL 16 per 30 days
UBRELVY 50 mg TabletUbrogepant3Preferred Brand$45.00$125.00
  • PA
  • QL 16 per 30 days
ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug50%50%None
ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug50%50%None
UPTRAVI 1000 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1200 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1400 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1600 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 200 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 400 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 600 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 800 ug Tablet, CoatedSelexipag5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI TITRATION PACK KitSelexipag5Specialty Tier33%N/A
  • PA
  • QL 2 per 30 days
URSODIOL 250 mg Tablet3Preferred Brand$45.00$125.00None
URSODIOL 300 mg Capsule3Preferred Brand$45.00$125.00None
URSODIOL 500 mg Tablet4Non-Preferred Drug50%50%None
USTEKINUMAB 45 mg/.5mL Injection, Solution5Specialty Tier33%N/A
  • PA
  • QL 1.5 per 84 days
USTEKINUMAB 45 mg/.5mL Injection, Solution5Specialty Tier33%N/A
  • PA
  • QL 1.5 per 84 days
USTEKINUMAB 90 mg/mL Injection, Solution5Specialty Tier33%N/A
  • PA
  • QL 3 per 84 days

PA = prior authorization, ST = step therapy, QL = quantity limit. Costs are the plan’s initial-coverage cost-sharing from the CMS 2026 formulary files; a drug not listed here is not on this plan’s formulary, though a formulary exception may still be possible.