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.
31 drugs starting with U.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| UBRELVY 100 mg TabletUbrogepant | 3Preferred Brand | 17% | 17% |
|
| UBRELVY 50 mg TabletUbrogepant | 3Preferred Brand | 17% | 17% |
|
| ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets | 4Non-Preferred Drug | 32% | 32% | None |
| ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets | 4Non-Preferred Drug | 32% | 32% | None |
| UNITHROID 100 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 112 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 125 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 137 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 150 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 175 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 200 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 25 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 300 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 50 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 75 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UNITHROID 88 ug TabletLevothyroxine Sodium | 2Generic | $3.00 | $6.00 | None |
| UPTRAVI 1000 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 1200 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 1400 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 1600 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 200 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 400 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 600 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI 800 ug Tablet, CoatedSelexipag | 5Specialty Tier | 25% | N/A |
|
| UPTRAVI TITRATION PACK KitSelexipag | 5Specialty Tier | 25% | N/A |
|
| URSODIOL 250 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| URSODIOL 300 mg Capsule | 4Non-Preferred Drug | 32% | 32% | None |
| URSODIOL 500 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| USTEKINUMAB 45 mg/.5mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
| USTEKINUMAB 45 mg/.5mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
| USTEKINUMAB 90 mg/mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
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.