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.

45 drugs starting with X.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
XALKORI 150 mg Capsule, Coated PelletsCrizotinib	5Specialty Tier	33%	N/A	PA QL 18 per 30 days
XALKORI 20 mg Capsule, Coated PelletsCrizotinib	5Specialty Tier	33%	N/A	PA QL 12 per 30 days
XALKORI 200 mg CapsuleCrizotinib	5Specialty Tier	33%	N/A	PA QL 12 per 30 days
XALKORI 250 mg CapsuleCrizotinib	5Specialty Tier	33%	N/A	PA QL 12 per 30 days
XALKORI 50 mg Capsule, Coated PelletsCrizotinib	5Specialty Tier	33%	N/A	PA QL 24 per 30 days
XARAH FE KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate Tablets	2Generic	$4.00	$0.00	None
XARELTO 10 mg Tablet, Film CoatedRivaroxaban	3Preferred Brand	$45.00	$125.00	QL 3 per 30 days
XARELTO 15 mg Tablet, Film CoatedRivaroxaban	3Preferred Brand	$45.00	$125.00	QL 6 per 30 days
XARELTO 155 mg Granule, For SuspensionRivaroxaban	3Preferred Brand	$45.00	$125.00	ST QL 6 per 30 days
XARELTO 2.5 mg Tablet, Film CoatedRivaroxaban	3Preferred Brand	$45.00	$125.00	QL 6 per 30 days
XARELTO 20 mg Tablet, Film CoatedRivaroxaban	3Preferred Brand	$45.00	$125.00	QL 3 per 30 days
XARELTO KitRivaroxaban	3Preferred Brand	$45.00	$125.00	QL 51 per 30 days
XATMEP 2.5 mg/mL SolutionMethotrexate	4Non-Preferred Drug	50%	50%	PA
XCOPRI 100 mg Tablet, Film CoatedCenobamate	4Non-Preferred Drug	50%	50%	PA QL 3 per 30 days
XCOPRI 150 mg Tablet, Film CoatedCenobamate	4Non-Preferred Drug	50%	50%	PA QL 6 per 30 days
XCOPRI 200 mg Tablet, Film CoatedCenobamate	4Non-Preferred Drug	50%	50%	PA QL 6 per 30 days
XCOPRI 25 mg Tablet, Film CoatedCenobamate	4Non-Preferred Drug	50%	50%	PA QL 3 per 30 days
XCOPRI 50 mg Tablet, Film CoatedCenobamate	4Non-Preferred Drug	50%	50%	PA QL 3 per 30 days
XCOPRI MAINTENANCE PACK KitCenobamate	4Non-Preferred Drug	50%	50%	PA QL 56 per 28 days
XCOPRI MAINTENANCE PACK KitCenobamate	4Non-Preferred Drug	50%	50%	PA QL 56 per 28 days
XCOPRI TITRATION PACK KitCenobamate	4Non-Preferred Drug	50%	50%	PA QL 28 per 28 days
XCOPRI TITRATION PACK KitCenobamate	4Non-Preferred Drug	50%	50%	PA QL 28 per 28 days
XCOPRI TITRATION PACK KitCenobamate	4Non-Preferred Drug	50%	50%	PA QL 28 per 28 days
XDEMVY 2.5 mg/mL Solution/ DropsLotilaner Ophthalmic Solution	4Non-Preferred Drug	50%	50%	PA QL 1 per 42 days
XERMELO 250 mg TabletTelotristat Ethyl	5Specialty Tier	33%	N/A	PA QL 84 per 28 days
XGEVA 120 mg/1.7mL InjectionDenosumab	5Specialty Tier	33%	N/A	PA QL 1.7 per 28 days
XIFAXAN 200 mg TabletRifaximin	4Non-Preferred Drug	50%	50%	PA QL 9 per 30 days
XIFAXAN 550 mg TabletRifaximin	5Specialty Tier	33%	N/A	PA QL 84 per 28 days
XOLAIR 300 mg/2mL Injection, SolutionOmalizumab	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XOLAIR 300 mg/2mL Injection, SolutionOmalizumab	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XOLAIR PFS 150 mg/mL Injection, SolutionOmalizumab	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XOLAIR PFS 75 mg/.5mL Injection, SolutionOmalizumab	5Specialty Tier	33%	N/A	PA QL 4 per 28 days
XOSPATA 40 mg TabletGilteritinib	5Specialty Tier	33%	N/A	PA QL 9 per 30 days
XPOVIO 10 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 16 per 28 days
XPOVIO 20 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 24 per 28 days
XPOVIO 20 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 32 per 28 days
XPOVIO 40 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XPOVIO 40 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XPOVIO 50 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 8 per 28 days
XPOVIO 60 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 4 per 28 days
XPOVIO 80 mg Tablet, Film CoatedSelinexor	5Specialty Tier	33%	N/A	PA QL 4 per 28 days
XTANDI 40 mg CapsuleEnzalutamide	5Specialty Tier	33%	N/A	PA QL 12 per 30 days
XTANDI 40 mg TabletEnzalutamide	5Specialty Tier	33%	N/A	PA QL 12 per 30 days
XTANDI 80 mg TabletEnzalutamide	5Specialty Tier	33%	N/A	PA QL 6 per 30 days
XULANE 150/35 ug/d PatchNorelgestromin And Ethinyl Estradiol	3Preferred Brand	$45.00	$125.00	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.