2026 Humana Premier Rx Plan (PDP) formulary (drug list)
Contract S5884, plan 156 · Georgia · 3,076 drugs on file · formulary ID 00026402. Each drug links to its cost in every CMS PDP Region 10 plan.
95 drugs starting with O.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate | 4Non-Preferred Drug | 50% | 50% |
|
| OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate | 4Non-Preferred Drug | 50% | 50% |
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| OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate | 4Non-Preferred Drug | 50% | 50% |
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| OCTREOTIDE ACETATE 200 ug/mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% |
|
| OCTREOTIDE ACETATE 50 ug/mL Injection, Solution | 3Preferred Brand | $45.00 | $125.00 |
|
| ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide | 5Specialty Tier | 33% | N/A |
|
| ODOMZO 200 mg CapsuleSonidegib | 5Specialty Tier | 33% | N/A |
|
| OFEV 100 mg CapsuleNintedanib | 5Specialty Tier | 33% | N/A |
|
| OFEV 150 mg CapsuleNintedanib | 5Specialty Tier | 33% | N/A |
|
| OFLOXACIN 3 mg/mL Solution | 2Generic | $4.00 | $0.00 | None |
| OFLOXACIN 3 mg/mL SolutionOfloxacin Otic | 3Preferred Brand | $45.00 | $125.00 | None |
| OGSIVEO 100 mg Tablet, Film CoatedNirogacestat | 5Specialty Tier | 33% | N/A |
|
| OGSIVEO 150 mg Tablet, Film CoatedNirogacestat | 5Specialty Tier | 33% | N/A |
|
| OJEMDA 100 mg Tablet, Film CoatedTovorafenib | 5Specialty Tier | 33% | N/A |
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| OJEMDA 100 mg Tablet, Film CoatedTovorafenib | 5Specialty Tier | 33% | N/A |
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| OJEMDA 100 mg Tablet, Film CoatedTovorafenib | 5Specialty Tier | 33% | N/A |
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| OJEMDA KitTovorafenib | 5Specialty Tier | 33% | N/A |
|
| OJJAARA 100 mg TabletMomelotinib | 5Specialty Tier | 33% | N/A |
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| OJJAARA 150 mg TabletMomelotinib | 5Specialty Tier | 33% | N/A |
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| OJJAARA 200 mg TabletMomelotinib | 5Specialty Tier | 33% | N/A |
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| OLANZAPINE 10 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLANZAPINE 10 mg Tablet, Orally Disintegrating | 4Non-Preferred Drug | 50% | 50% |
|
| OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| OLANZAPINE 15 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLANZAPINE 15 mg Tablet, Orally Disintegrating | 4Non-Preferred Drug | 50% | 50% |
|
| OLANZAPINE 2.5 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLANZAPINE 20 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLANZAPINE 20 mg Tablet, Orally Disintegrating | 4Non-Preferred Drug | 50% | 50% |
|
| OLANZAPINE 5 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLANZAPINE 5 mg Tablet, Orally Disintegrating | 4Non-Preferred Drug | 50% | 50% |
|
| OLANZAPINE 7.5 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OLMESARTAN MEDOXOMIL / AMLODIPINE BESYLATE / HYDROCHLOROTHIAZIDE 40/10/12.5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| OLMESARTAN MEDOXOMIL / AMLODIPINE BESYLATE / HYDROCHLOROTHIAZIDE 40/10/25 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
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| OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet | 2Generic | $4.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet | 2Generic | $4.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet | 2Generic | $4.00 | $0.00 |
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| OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 20/5/12.5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
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| OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 40/5/12.5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
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| OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 40/5/25 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
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| OMEGA-3-ACID ETHYL ESTERS 900 mg Capsule | 3Preferred Brand | $45.00 | $125.00 |
|
| OMEPRAZOLE 10 mg Capsule, Delayed Release | 1Preferred Generic | $0.00 | $0.00 | None |
| OMEPRAZOLE 20 mg Capsule, Delayed Release | 1Preferred Generic | $0.00 | $0.00 | None |
| OMEPRAZOLE 40 mg Capsule, Delayed Release | 1Preferred Generic | $0.00 | $0.00 | None |
| OMNITROPE 10 mg/1.5mL Injection, SolutionSomatropin | 5Specialty Tier | 33% | N/A |
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| OMNITROPE 5 mg/1.5mL Injection, SolutionSomatropin | 5Specialty Tier | 33% | N/A |
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| OMNITROPE KitSomatropin | 5Specialty Tier | 33% | N/A |
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| ONDANSETRON 4 mg Tablet, Orally Disintegrating | 2Generic | $4.00 | $0.00 |
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| ONDANSETRON 8 mg Tablet, Orally Disintegrating | 2Generic | $4.00 | $0.00 |
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| ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated | 2Generic | $4.00 | $0.00 |
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| ONDANSETRON HYDROCHLORIDE 4 mg/5mL Solution | 4Non-Preferred Drug | 50% | 50% |
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| ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated | 2Generic | $4.00 | $0.00 |
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| ONUREG 200 mg Tablet, Film CoatedAzacitidine | 5Specialty Tier | 33% | N/A |
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| ONUREG 300 mg Tablet, Film CoatedAzacitidine | 5Specialty Tier | 33% | N/A |
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| OPIPZA 10 mg Film, SolubleAripiprazole | 5Specialty Tier | 33% | N/A |
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| OPIPZA 2 mg Film, SolubleAripiprazole | 5Specialty Tier | 33% | N/A |
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| OPIPZA 5 mg Film, SolubleAripiprazole | 5Specialty Tier | 33% | N/A |
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| OPVEE 2.7 mg/100uL SprayNalmefene Hydrochloride | 3Preferred Brand | $45.00 | $125.00 | None |
| ORGOVYX 120 mg Tablet, Film CoatedRelugolix | 5Specialty Tier | 33% | N/A |
|
| ORQUIDEA .35 mg TabletNorethindrone | 2Generic | $4.00 | $0.00 | None |
| ORSERDU 345 mg Tablet, Film CoatedElacestrant | 5Specialty Tier | 33% | N/A |
|
| ORSERDU 86 mg Tablet, Film CoatedElacestrant | 5Specialty Tier | 33% | N/A |
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| OSELTAMIVIR PHOSPHATE 30 mg Capsule | 2Generic | $4.00 | $0.00 |
|
| OSELTAMIVIR PHOSPHATE 45 mg Capsule | 2Generic | $4.00 | $0.00 |
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| OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension | 4Non-Preferred Drug | 50% | 50% |
|
| OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir | 3Preferred Brand | $45.00 | $125.00 |
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| OTULFI 45 mg/.5mL Injection, SolutionUstekinumab-Aauz | 3Preferred Brand | $45.00 | $125.00 |
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| OTULFI 45 mg/.5mL Injection, SolutionUstekinumab-Aauz | 3Preferred Brand | $45.00 | $125.00 |
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| OTULFI 90 mg/mL Injection, SolutionUstekinumab-Aauz | 5Specialty Tier | 33% | N/A |
|
| OXCARBAZEPINE 150 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OXCARBAZEPINE 300 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OXCARBAZEPINE 300 mg/5mL Suspension | 4Non-Preferred Drug | 50% | 50% | None |
| OXCARBAZEPINE 600 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release | 3Preferred Brand | $45.00 | $125.00 |
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| OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release | 3Preferred Brand | $45.00 | $125.00 |
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| OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release | 3Preferred Brand | $45.00 | $125.00 |
|
| OXYBUTYNIN CHLORIDE 5 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup | 2Generic | $4.00 | $0.00 | None |
| OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE HYDROCHLORIDE 10 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE HYDROCHLORIDE 100 mg/5mL Solution | 4Non-Preferred Drug | 50% | 50% |
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| OXYCODONE HYDROCHLORIDE 15 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE HYDROCHLORIDE 20 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE HYDROCHLORIDE 30 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
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| OXYCODONE HYDROCHLORIDE 5 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
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| OXYCODONE HYDROCHLORIDE 5 mg Tablet | 3Preferred Brand | $45.00 | $125.00 |
|
| OXYCODONE HYDROCHLORIDE 5 mg/5mL Solution | 4Non-Preferred Drug | 50% | 50% |
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| OZEMPIC .68 mg/mL Injection, SolutionSemaglutide | 3Preferred Brand | $45.00 | $125.00 |
|
| OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide | 3Preferred Brand | $45.00 | $125.00 |
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| OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide | 3Preferred Brand | $45.00 | $125.00 |
|
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.