2026 Blue MedicareRx Value Plus (PDP) formulary (drug list)

Contract S2893, plan 001 · Connecticut · 3,150 drugs on file · formulary ID 00026129. Each drug links to its cost in every CMS PDP Region 02 plan.

89 drugs starting with O.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
OCTAGAM IMMUNE GLOBULIN (HUMAN) 100 mg/mL SolutionImmune Globulin	5Specialty Tier	25%	N/A	PA
OCTAGAM IMMUNE GLOBULIN (HUMAN) 50 mg/mL SolutionImmune Globulin	5Specialty Tier	25%	N/A	PA
OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate	4Non-Preferred Drug	32%	32%	PA
OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate	5Specialty Tier	25%	N/A	PA
OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate	5Specialty Tier	25%	N/A	PA
OCTREOTIDE ACETATE 200 ug/mL Injection, Solution	4Non-Preferred Drug	32%	32%	PA
OCTREOTIDE ACETATE 50 ug/mL Injection, Solution	4Non-Preferred Drug	32%	32%	PA
ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide	5Specialty Tier	25%	N/A	None
ODOMZO 200 mg CapsuleSonidegib	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
OFEV 100 mg CapsuleNintedanib	5Specialty Tier	25%	N/A	PA QL 6 per 30 days
OFEV 150 mg CapsuleNintedanib	5Specialty Tier	25%	N/A	PA QL 6 per 30 days
OFLOXACIN 3 mg/mL Solution	2Generic	$3.00	$6.00	None
OFLOXACIN 3 mg/mL SolutionOfloxacin Otic	4Non-Preferred Drug	32%	32%	None
OGSIVEO 100 mg Tablet, Film CoatedNirogacestat	5Specialty Tier	25%	N/A	PA QL 56 per 28 days
OGSIVEO 150 mg Tablet, Film CoatedNirogacestat	5Specialty Tier	25%	N/A	PA QL 56 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib	5Specialty Tier	25%	N/A	PA QL 24 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib	5Specialty Tier	25%	N/A	PA QL 24 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib	5Specialty Tier	25%	N/A	PA QL 24 per 28 days
OJEMDA KitTovorafenib	5Specialty Tier	25%	N/A	PA QL 96 per 28 days
OJJAARA 100 mg TabletMomelotinib	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
OJJAARA 150 mg TabletMomelotinib	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
OJJAARA 200 mg TabletMomelotinib	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
OLANZAPINE 10 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 6 per 30 days
OLANZAPINE 10 mg Tablet, Orally Disintegrating	4Non-Preferred Drug	32%	32%	ST QL 6 per 30 days
OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution	4Non-Preferred Drug	32%	32%	QL 3 per 1 days
OLANZAPINE 15 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 3 per 30 days
OLANZAPINE 15 mg Tablet, Orally Disintegrating	4Non-Preferred Drug	32%	32%	ST QL 3 per 30 days
OLANZAPINE 2.5 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 6 per 30 days
OLANZAPINE 20 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 3 per 30 days
OLANZAPINE 20 mg Tablet, Orally Disintegrating	4Non-Preferred Drug	32%	32%	ST QL 3 per 30 days
OLANZAPINE 5 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 6 per 30 days
OLANZAPINE 5 mg Tablet, Orally Disintegrating	4Non-Preferred Drug	32%	32%	ST QL 3 per 30 days
OLANZAPINE 7.5 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 3 per 30 days
OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 3 per 30 days
OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 3 per 30 days
OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated	3Preferred Brand	17%	17%	QL 6 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet	3Preferred Brand	17%	17%	QL 3 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet	3Preferred Brand	17%	17%	QL 3 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet	3Preferred Brand	17%	17%	QL 3 per 30 days
OMEGA-3-ACID ETHYL ESTERS 900 mg Capsule	3Preferred Brand	17%	17%	PA
OMEPRAZOLE 10 mg Capsule, Delayed Release	2Generic	$3.00	$6.00	None
OMEPRAZOLE 20 mg Capsule, Delayed Release	2Generic	$3.00	$6.00	None
OMEPRAZOLE 40 mg Capsule, Delayed Release	2Generic	$3.00	$6.00	None
ONDANSETRON 4 mg Tablet, Orally Disintegrating	3Preferred Brand	17%	17%	PA
ONDANSETRON 8 mg Tablet, Orally Disintegrating	3Preferred Brand	17%	17%	PA
ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated	3Preferred Brand	17%	17%	PA
ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated	3Preferred Brand	17%	17%	PA
ONUREG 200 mg Tablet, Film CoatedAzacitidine	5Specialty Tier	25%	N/A	PA QL 14 per 28 days
ONUREG 300 mg Tablet, Film CoatedAzacitidine	5Specialty Tier	25%	N/A	PA QL 14 per 28 days
OPIPZA 10 mg Film, SolubleAripiprazole	4Non-Preferred Drug	32%	32%	PA QL 9 per 30 days
OPIPZA 2 mg Film, SolubleAripiprazole	4Non-Preferred Drug	32%	32%	PA QL 3 per 30 days
OPIPZA 5 mg Film, SolubleAripiprazole	4Non-Preferred Drug	32%	32%	PA QL 3 per 30 days
OPSUMIT 10 mg Tablet, Film CoatedMacitentan	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
ORGOVYX 120 mg Tablet, Film CoatedRelugolix	5Specialty Tier	25%	N/A	PA
ORKAMBI 100/125 mg GranuleLumacaftor And Ivacaftor	5Specialty Tier	25%	N/A	PA QL 56 per 28 days
ORKAMBI 100/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor	5Specialty Tier	25%	N/A	PA QL 112 per 28 days
ORKAMBI 150/188 mg GranuleLumacaftor And Ivacaftor	5Specialty Tier	25%	N/A	PA QL 56 per 28 days
ORKAMBI 200/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor	5Specialty Tier	25%	N/A	PA QL 112 per 28 days
ORKAMBI 75/94 mg GranuleLumacaftor And Ivacaftor	5Specialty Tier	25%	N/A	PA QL 56 per 28 days
ORQUIDEA .35 mg TabletNorethindrone	3Preferred Brand	17%	17%	None
ORSERDU 345 mg Tablet, Film CoatedElacestrant	5Specialty Tier	25%	N/A	PA QL 3 per 30 days
ORSERDU 86 mg Tablet, Film CoatedElacestrant	5Specialty Tier	25%	N/A	PA QL 9 per 30 days
OSELTAMIVIR PHOSPHATE 30 mg Capsule	3Preferred Brand	17%	17%	QL 168 per 365 days
OSELTAMIVIR PHOSPHATE 45 mg Capsule	3Preferred Brand	17%	17%	QL 84 per 365 days
OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension	3Preferred Brand	17%	17%	QL 108 per 365 days
OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir	3Preferred Brand	17%	17%	QL 84 per 365 days
OSPOMYV 60 mg/mL Injection, SolutionDenosumab	4Non-Preferred Drug	32%	32%	QL 1 per 180 days
OXCARBAZEPINE 150 mg Tablet, Film Coated	3Preferred Brand	17%	17%	None
OXCARBAZEPINE 300 mg Tablet, Film Coated	3Preferred Brand	17%	17%	None
OXCARBAZEPINE 300 mg/5mL Suspension	4Non-Preferred Drug	32%	32%	None
OXCARBAZEPINE 600 mg Tablet, Film Coated	3Preferred Brand	17%	17%	None
OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release	3Preferred Brand	17%	17%	QL 6 per 30 days
OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release	3Preferred Brand	17%	17%	QL 3 per 30 days
OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release	3Preferred Brand	17%	17%	QL 6 per 30 days
OXYBUTYNIN CHLORIDE 5 mg Tablet	3Preferred Brand	17%	17%	QL 12 per 30 days
OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup	3Preferred Brand	17%	17%	QL 6 per 30 days
OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet	3Preferred Brand	17%	17%	QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen	3Preferred Brand	17%	17%	QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen	3Preferred Brand	17%	17%	QL 24 per 30 days
OXYCODONE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 15 mg Tablet	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 20 mg Tablet	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 30 mg Tablet	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 5 mg Tablet	3Preferred Brand	17%	17%	QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 5 mg/5mL Solution	4Non-Preferred Drug	32%	32%	QL 9 per 30 days
OZEMPIC .68 mg/mL Injection, SolutionSemaglutide	3Preferred Brand	17%	17%	PA QL 3 per 28 days
OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide	3Preferred Brand	17%	17%	PA QL 3 per 28 days
OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide	3Preferred Brand	17%	17%	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.