2026 Humana Value Rx Plan (PDP) formulary (drug list)

Contract S5884, plan 189 · Georgia · 3,009 drugs on file · formulary ID 00026400. Each drug links to its cost in every CMS PDP Region 10 plan.

19 drugs starting with U.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
UBRELVY 100 mg TabletUbrogepant	3Preferred Brand	20%	15%	PA QL 16 per 30 days
UBRELVY 50 mg TabletUbrogepant	3Preferred Brand	20%	15%	PA QL 16 per 30 days
ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets	4Non-Preferred Drug	34%	N/A	None
ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets	4Non-Preferred Drug	34%	N/A	None
UPTRAVI 1000 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 1200 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 1400 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 1600 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 200 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 400 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 600 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI 800 ug Tablet, CoatedSelexipag	5Specialty Tier	26%	N/A	PA QL 6 per 30 days
UPTRAVI TITRATION PACK KitSelexipag	5Specialty Tier	26%	N/A	PA QL 2 per 30 days
URSODIOL 250 mg Tablet	3Preferred Brand	20%	15%	None
URSODIOL 300 mg Capsule	3Preferred Brand	20%	15%	None
URSODIOL 500 mg Tablet	4Non-Preferred Drug	34%	N/A	None
USTEKINUMAB 45 mg/.5mL Injection, Solution	5Specialty Tier	26%	N/A	PA QL 1.5 per 84 days
USTEKINUMAB 45 mg/.5mL Injection, Solution	5Specialty Tier	26%	N/A	PA QL 1.5 per 84 days
USTEKINUMAB 90 mg/mL Injection, Solution	5Specialty Tier	26%	N/A	PA QL 3 per 84 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.