MedicarePartD.guide

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2026 HealthSpring Assurance Rx (PDP) formulary (drug list)

Contract S5617, plan 225 · Arkansas · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 19 plan.

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112 drugs starting with O.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug29%29%
  • PA
OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug29%29%
  • PA
OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug29%29%
  • PA
OCTREOTIDE ACETATE 200 ug/mL Injection, Solution4Non-Preferred Drug29%29%
  • PA
OCTREOTIDE ACETATE 50 ug/mL Injection, Solution4Non-Preferred Drug29%29%
  • PA
ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide5Specialty Tier25%N/A
  • QL 3 per 30 days
ODOMZO 200 mg CapsuleSonidegib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OFEV 100 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OFEV 150 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OFLOXACIN 3 mg/mL Solution2Generic10%10%None
OFLOXACIN 3 mg/mL SolutionOfloxacin Otic4Non-Preferred Drug29%29%None
OGSIVEO 100 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
OGSIVEO 150 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 16 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 2 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 24 per 28 days
OJEMDA KitTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 96 per 28 days
OJJAARA 100 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OJJAARA 150 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OJJAARA 200 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OLANZAPINE 10 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLANZAPINE 10 mg Tablet, Orally Disintegrating4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug29%29%
  • QL 3 per 30 days
OLANZAPINE 15 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 3 per 30 days
OLANZAPINE 15 mg Tablet, Orally Disintegrating4Non-Preferred Drug29%29%
  • QL 3 per 30 days
OLANZAPINE 2.5 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLANZAPINE 20 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 3 per 30 days
OLANZAPINE 20 mg Tablet, Orally Disintegrating4Non-Preferred Drug29%29%
  • QL 3 per 30 days
OLANZAPINE 5 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLANZAPINE 5 mg Tablet, Orally Disintegrating4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLANZAPINE 7.5 mg Tablet, Film Coated4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated1Preferred Generic5%5%None
OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated1Preferred Generic5%5%None
OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated1Preferred Generic5%5%None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet1Preferred Generic5%5%None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet1Preferred Generic5%5%None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet1Preferred Generic5%5%None
OMEPRAZOLE 10 mg Capsule, Delayed Release2Generic10%10%
  • QL 6 per 30 days
OMEPRAZOLE 20 mg Capsule, Delayed Release2Generic10%10%
  • QL 6 per 30 days
OMEPRAZOLE 40 mg Capsule, Delayed Release2Generic10%10%
  • QL 6 per 30 days
ONDANSETRON 4 mg Tablet, Orally Disintegrating2Generic10%10%
  • PA
ONDANSETRON 8 mg Tablet, Orally Disintegrating2Generic10%10%
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated2Generic10%10%
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg/5mL Solution4Non-Preferred Drug29%29%
  • PA
ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated2Generic10%10%
  • PA
ONGENTYS 25 mg CapsuleOpicapone3Preferred Brand25%25%None
ONGENTYS 50 mg CapsuleOpicapone3Preferred Brand25%25%None
ONUREG 200 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
ONUREG 300 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
OPIPZA 10 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • ST
  • QL 9 per 30 days
OPIPZA 2 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • ST
  • QL 6 per 30 days
OPIPZA 5 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • ST
  • QL 6 per 30 days
ORENITRAM .125 mg Tablet, Extended ReleaseTreprostinil4Non-Preferred Drug29%29%
  • PA
ORENITRAM .25 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 1 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 2.5 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 5 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
ORGOVYX 120 mg Tablet, Film CoatedRelugolix5Specialty Tier25%N/A
  • PA
  • QL 3 per 28 days
ORKAMBI 100/125 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
ORKAMBI 100/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
ORKAMBI 150/188 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
ORKAMBI 200/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
ORKAMBI 75/94 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
ORQUIDEA .35 mg TabletNorethindrone4Non-Preferred Drug29%29%None
ORSERDU 345 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
ORSERDU 86 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
OSELTAMIVIR PHOSPHATE 30 mg Capsule3Preferred Brand25%25%None
OSELTAMIVIR PHOSPHATE 45 mg Capsule3Preferred Brand25%25%None
OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension4Non-Preferred Drug29%29%None
OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir3Preferred Brand25%25%None
OTEZLA 20 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA 30 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA 75 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 82 per 365 days
OXACILLIN 1 g/20mL Injection, Powder, For Solution4Non-Preferred Drug29%29%
  • PA
OXACILLIN 10 g/100mL Injection, Powder, For SolutionOxacillin Sodium4Non-Preferred Drug29%29%
  • PA
OXACILLIN 2 g/20mL Injection, Powder, For Solution4Non-Preferred Drug29%29%
  • PA
OXAPROZIN 600 mg Tablet, Film Coated4Non-Preferred Drug29%29%None
OXCARBAZEPINE 150 mg Tablet, Film Coated3Preferred Brand25%25%None
OXCARBAZEPINE 300 mg Tablet, Film Coated3Preferred Brand25%25%None
OXCARBAZEPINE 300 mg/5mL Suspension4Non-Preferred Drug29%29%None
OXCARBAZEPINE 600 mg Tablet, Film Coated3Preferred Brand25%25%None
OXERVATE 20 ug/mL Solution/ DropsCenegermin-Bkbj5Specialty Tier25%N/A
  • PA
  • QL 112 per 56 days
OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release4Non-Preferred Drug29%29%
  • QL 6 per 30 days
OXYBUTYNIN CHLORIDE 5 mg Tablet2Generic10%10%None
OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup2Generic10%10%None
OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand25%25%
  • QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand25%25%
  • QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand25%25%
  • QL 36 per 30 days
OXYCODONE HYDROCHLORIDE 10 mg Tablet3Preferred Brand25%25%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 15 mg Tablet3Preferred Brand25%25%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 20 mg Tablet3Preferred Brand25%25%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 30 mg Tablet3Preferred Brand25%25%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 5 mg Tablet3Preferred Brand25%25%
  • QL 36 per 30 days
OXYMORPHONE HYDROCHLORIDE 10 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 15 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 20 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 30 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 40 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 5 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OXYMORPHONE HYDROCHLORIDE 7.5 mg Tablet, Film Coated, Extended Release4Non-Preferred Drug29%29%
  • QL 9 per 30 days
OZEMPIC .68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 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.