MedicarePartD.guide

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2026 Wellcare Classic (PDP) formulary (drug list)

Contract S4802, plan 095 · Hawaii · 2,922 drugs on file · formulary ID 00026191. Each drug links to its cost in every CMS PDP Region 33 plan.

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181 drugs starting with L.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
L-GLUTAMINE 5 g Powder, For Solution5Specialty Tier25%N/A
  • PA
LABETALOL HYDROCHLORIDE 100 mg Tablet, Film Coated3Preferred Brand25%25%None
LABETALOL HYDROCHLORIDE 200 mg Tablet, Film Coated3Preferred Brand25%25%None
LABETALOL HYDROCHLORIDE 300 mg Tablet, Film Coated3Preferred Brand25%25%None
LACOSAMIDE 100 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 6 per 30 days
LACOSAMIDE 150 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 6 per 30 days
LACOSAMIDE 200 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 6 per 30 days
LACOSAMIDE 50 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 12 per 30 days
LACOSAMIDE ORAL SOLUTION 10 mg/mL Solution4Non-Preferred Drug35%35%
  • QL 12 per 30 days
LACTULOSE 10 g/15mL Solution4Non-Preferred Drug35%35%None
LAMIVUDINE 100 mg Tablet, Film Coated4Non-Preferred Drug35%35%None
LAMIVUDINE 150 mg Tablet4Non-Preferred Drug35%35%None
LAMIVUDINE 300 mg Tablet, Film Coated4Non-Preferred Drug35%35%None
LAMIVUDINE AND ZIDOVUDINE 150/300 mg Tablet, Film Coated4Non-Preferred Drug35%35%None
LAMOTRIGINE 100 mg Tablet2Generic$10.00$30.00None
LAMOTRIGINE 150 mg Tablet2Generic$10.00$30.00None
LAMOTRIGINE 200 mg Tablet2Generic$10.00$30.00None
LAMOTRIGINE 25 mg Tablet2Generic$10.00$30.00None
LAMOTRIGINE 25 mg Tablet, Chewable4Non-Preferred Drug35%35%None
LAMOTRIGINE 5 mg Tablet, Chewable4Non-Preferred Drug35%35%None
LANSOPRAZOLE 15 mg Capsule, Delayed Release3Preferred Brand25%25%
  • QL 6 per 30 days
LANSOPRAZOLE 30 mg Capsule, Delayed Release3Preferred Brand25%25%
  • QL 6 per 30 days
LANTUS 100 [iU]/mL Injection, SolutionInsulin Glargine3Preferred Brand25%25%None
LANTUS SOLOSTAR 100 [iU]/mL Injection, SolutionInsulin Glargine3Preferred Brand25%25%None
LAPATINIB 250 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
LARIN 1.5/30 KitNorethindrone Acetate/Ethinyl Estradiol3Preferred Brand25%25%None
LARIN 1/20 KitNorethindrone Acetate/Ethinyl Estradiol3Preferred Brand25%25%None
LARIN FE 1.5/30 KitNorethindrone Acetate/Ethinyl Estradiol And Ferrous Fumarate3Preferred Brand25%25%None
LARIN FE 1/20 KitNorethindrone Acetate/Ethinyl Estradiol And Ferrous Fumarate3Preferred Brand25%25%None
LATANOPROST 50 ug/mL Solution1Preferred Generic$0.00$0.00None
LAZCLUZE 240 mg Tablet, Film CoatedLazertinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LAZCLUZE 80 mg Tablet, Film CoatedLazertinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
LEDIPASVIR AND SOFOSBUVIR 90/400 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LEFLUNOMIDE 10 mg Tablet4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LEFLUNOMIDE 20 mg Tablet4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LENALIDOMIDE 10 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENALIDOMIDE 15 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENALIDOMIDE 2.5 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENALIDOMIDE 20 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENALIDOMIDE 25 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENALIDOMIDE 5 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
LENVIMA 10 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENVIMA 10 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LESSINA KitLevonorgestrel And Ethinyl Estradiol3Preferred Brand25%25%None
LETROZOLE 2.5 mg Tablet2Generic$10.00$30.00None
LEUCOVORIN CALCIUM 10 mg Tablet4Non-Preferred Drug35%35%None
LEUCOVORIN CALCIUM 15 mg Tablet4Non-Preferred Drug35%35%None
LEUCOVORIN CALCIUM 25 mg Tablet4Non-Preferred Drug35%35%None
LEUCOVORIN CALCIUM 5 mg Tablet4Non-Preferred Drug35%35%None
LEUKERAN 2 mg Tablet, Film CoatedChlorambucil5Specialty Tier25%N/ANone
LEUPROLIDE ACETATE Kit4Non-Preferred Drug35%35%
  • PA
LEVETIRACETAM 100 mg/mL SolutionLevetiracetam Oral4Non-Preferred Drug35%35%None
LEVETIRACETAM 1000 mg Tablet, Film Coated3Preferred Brand25%25%None
LEVETIRACETAM 250 mg Tablet, Film Coated3Preferred Brand25%25%None
LEVETIRACETAM 250 mg Tablet, For Suspension3Preferred Brand25%25%None
LEVETIRACETAM 500 mg Tablet3Preferred Brand25%25%None
LEVETIRACETAM 500 mg Tablet, Film Coated3Preferred Brand25%25%None
LEVETIRACETAM 500 mg Tablet, For Suspension3Preferred Brand25%25%None
LEVETIRACETAM 750 mg Tablet, Film Coated3Preferred Brand25%25%None
LEVOBUNOLOL HYDROCHLORIDE 5 mg/mL Solution/ Drops2Generic$10.00$30.00None
LEVOCARNITINE 1 g/10mL Solution4Non-Preferred Drug35%35%None
LEVOCARNITINE 330 mg Tablet4Non-Preferred Drug35%35%None
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg Tablet3Preferred Brand25%25%None
LEVOFLOXACIN 25 mg/mL Solution4Non-Preferred Drug35%35%None
LEVOFLOXACIN 250 mg Tablet, Film Coated2Generic$10.00$30.00None
LEVOFLOXACIN 5 mg/mL Injection, Solution4Non-Preferred Drug35%35%None
LEVOFLOXACIN 5 mg/mL Injection, Solution4Non-Preferred Drug35%35%None
LEVOFLOXACIN 500 mg Tablet, Film Coated2Generic$10.00$30.00None
LEVOFLOXACIN 750 mg Tablet, Film Coated2Generic$10.00$30.00None
LEVONEST KitLevonorgestrel And Ethinyl Estradiol3Preferred Brand25%25%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand25%25%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand25%25%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand25%25%None
LEVOTHYROXINE SODIUM .2 mg Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM .3 mg Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 100 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 112 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 125 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 137 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 150 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 175 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 25 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 50 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 75 ug Tablet2Generic$10.00$30.00None
LEVOTHYROXINE SODIUM 88 ug Tablet2Generic$10.00$30.00None
LIDOCAINE 50 mg/g Ointment4Non-Preferred Drug35%35%
  • QL 5 per 30 days
LIDOCAINE 700 mg Patch4Non-Preferred Drug35%35%
  • PA
  • QL 9 per 30 days
LIDOCAINE AND PRILOCAINE 25/25 mg/g Cream2Generic$10.00$30.00
  • QL 3 per 30 days
LIDOCAINE HYDROCHLORIDE 40 mg/mL Solution4Non-Preferred Drug35%35%
  • QL 5 per 30 days
LIDOCAINE VISCOUS 20 mg/mL SolutionLidocaine Hydrochloride4Non-Preferred Drug35%35%None
LIDOCAN III 50 mg/g PatchLidocaine 5%4Non-Preferred Drug35%35%
  • PA
  • QL 9 per 30 days
LILETTA 52 mg Intrauterine DeviceLevonorgestrel3Preferred Brand25%25%None
LINEZOLID 100 mg/5mL Granule, For Suspension5Specialty Tier25%N/A
  • QL 18 per 30 days
LINEZOLID 600 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 6 per 30 days
LINEZOLID 600 mg/300mL Injection, Solution4Non-Preferred Drug35%35%None
LINZESS 145 ug Capsule, Gelatin CoatedLinaclotide4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LINZESS 290 ug Capsule, Gelatin CoatedLinaclotide4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LINZESS 72 ug Capsule, Gelatin CoatedLinaclotide4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LIOMNY 25 ug TabletLiothyronine Sodium3Preferred Brand25%25%None
LIOMNY 5 ug TabletLiothyronine Sodium3Preferred Brand25%25%None
LIOMNY 50 ug TabletLiothyronine Sodium3Preferred Brand25%25%None
LIOTHYRONINE SODIUM 25 ug Tablet3Preferred Brand25%25%None
LIOTHYRONINE SODIUM 5 ug Tablet3Preferred Brand25%25%None
LIOTHYRONINE SODIUM 50 ug Tablet3Preferred Brand25%25%None
LISINOPRIL 10 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL 2.5 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL 20 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL 30 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL 40 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL 5 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL AND HYDROCHLOROTHIAZIDE 12.5/10 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL AND HYDROCHLOROTHIAZIDE 12.5/20 mg Tablet1Preferred Generic$0.00$0.00None
LISINOPRIL AND HYDROCHLOROTHIAZIDE 25/20 mg Tablet1Preferred Generic$0.00$0.00None
LITHIUM 8 meq/5mL Solution2Generic$10.00$30.00None
LITHIUM CARBONATE 150 mg Capsule2Generic$10.00$30.00None
LITHIUM CARBONATE 300 mg Capsule2Generic$10.00$30.00None
LITHIUM CARBONATE 300 mg Tablet2Generic$10.00$30.00None
LITHIUM CARBONATE 300 mg Tablet, Film Coated, Extended Release2Generic$10.00$30.00None
LITHIUM CARBONATE 600 mg Capsule, Gelatin Coated2Generic$10.00$30.00None
LITHIUM CARBONATE ER 450 mg TabletLithium Carbonate2Generic$10.00$30.00None
LIVTENCITY 200 mg Tablet, CoatedMaribavir5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LOKELMA 10 g/10g Powder, For SuspensionSodium Zirconium Cyclosilicate3Preferred Brand25%25%None
LOKELMA 5 g/5g Powder, For SuspensionSodium Zirconium Cyclosilicate3Preferred Brand25%25%None
LOMUSTINE 10 mg Capsule4Non-Preferred Drug35%35%None
LOMUSTINE 100 mg Capsule5Specialty Tier25%N/ANone
LOMUSTINE 40 mg Capsule5Specialty Tier25%N/ANone
LONSURF 15/6.14 mg Tablet, Film CoatedTrifluridine And Tipiracil5Specialty Tier25%N/A
  • PA
LONSURF 20/8.19 mg Tablet, Film CoatedTrifluridine And Tipiracil5Specialty Tier25%N/A
  • PA
LOPERAMIDE HYDROCHLORIDE 2 mg Capsule3Preferred Brand25%25%None
LOPINAVIR AND RITONAVIR 100/25 mg Tablet, Film Coated4Non-Preferred Drug35%35%None
LOPINAVIR AND RITONAVIR 200/50 mg Tablet, Film Coated4Non-Preferred Drug35%35%None
LORAZEPAM .5 mg Tablet2Generic$10.00$30.00
  • QL 15 per 30 days
LORAZEPAM 1 mg Tablet2Generic$10.00$30.00
  • QL 15 per 30 days
LORAZEPAM 2 mg Tablet2Generic$10.00$30.00
  • QL 15 per 30 days
LORAZEPAM 2 mg/mL Solution, Concentrate4Non-Preferred Drug35%35%
  • QL 15 per 30 days
LORBRENA 100 mg Tablet, Film CoatedLorlatinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LORBRENA 25 mg Tablet, Film CoatedLorlatinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LORYNA KitDrospirenone And Ethinyl Estradiol Tablets3Preferred Brand25%25%None
LOSARTAN POTASSIUM 100 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
LOSARTAN POTASSIUM 25 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
LOSARTAN POTASSIUM 50 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 12.5/100 mg Tablet2Generic$10.00$30.00
  • QL 3 per 30 days
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 12.5/50 mg Tablet2Generic$10.00$30.00
  • QL 6 per 30 days
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 25/100 mg Tablet2Generic$10.00$30.00
  • QL 3 per 30 days
LOTEPREDNOL ETABONATE 2 mg/mL Suspension/ Drops4Non-Preferred Drug35%35%None
LOVASTATIN 10 mg Tablet1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
LOVASTATIN 20 mg Tablet1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
LOVASTATIN 40 mg Tablet1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
LOW-OGESTREL KitNorgestrel And Ethinyl Estradiol3Preferred Brand25%25%None
LOXAPINE 10 mg Capsule4Non-Preferred Drug35%35%None
LOXAPINE 25 mg Capsule4Non-Preferred Drug35%35%None
LOXAPINE 5 mg Capsule4Non-Preferred Drug35%35%None
LOXAPINE 50 mg Capsule4Non-Preferred Drug35%35%None
LUMAKRAS 120 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 24 per 30 days
LUMAKRAS 240 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LUMAKRAS 320 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
LURASIDONE HYDROCHLORIDE 120 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 20 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 40 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 60 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 80 mg Tablet, Film Coated4Non-Preferred Drug35%35%
  • QL 6 per 30 days
LYLEQ .35 mg TabletNorethindrone3Preferred Brand25%25%None
LYLLANA .025 mg/d Patch, Extended ReleaseEstradiol4Non-Preferred Drug35%35%
  • QL 8 per 28 days
LYLLANA .0375 mg/d Patch, Extended ReleaseEstradiol4Non-Preferred Drug35%35%
  • QL 8 per 28 days
LYLLANA .05 mg/d Patch, Extended ReleaseEstradiol4Non-Preferred Drug35%35%
  • QL 8 per 28 days
LYLLANA .075 mg/d Patch, Extended ReleaseEstradiol4Non-Preferred Drug35%35%
  • QL 8 per 28 days
LYLLANA .1 mg/d Patch, Extended ReleaseEstradiol4Non-Preferred Drug35%35%
  • QL 8 per 28 days
LYNPARZA 100 mg Tablet, Film CoatedOlaparib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LYNPARZA 150 mg Tablet, Film CoatedOlaparib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LYSODREN 500 mg TabletMitotane5Specialty Tier25%N/ANone
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 84 per 28 days
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 14 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.