MedicarePartD.guide

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2026 Blue MedicareRx Value (PDP) formulary (drug list)

Contract S5726, plan 013 · Kansas · 2,948 drugs on file · formulary ID 00026284. Each drug links to its cost in every CMS PDP Region 24 plan.

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107 drugs starting with I.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
IBANDRONATE SODIUM 150 mg Tablet2Generic$2.00$6.00
  • QL 1 per 28 days
IBRANCE 100 mg CapsulePalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBRANCE 100 mg Tablet, Film CoatedPalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBRANCE 125 mg CapsulePalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBRANCE 125 mg Tablet, Film CoatedPalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBRANCE 75 mg CapsulePalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBRANCE 75 mg Tablet, Film CoatedPalbociclib5Specialty Tier25%N/A
  • PA
  • QL 21 per 28 days
IBU 600 mg TabletIbuprofen2Generic$2.00$6.00
  • QL 15 per 30 days
IBU 800 mg TabletIbuprofen2Generic$2.00$6.00
  • QL 12 per 30 days
IBUPROFEN 100 mg/5mL Suspension2Generic$2.00$6.00None
IBUPROFEN 400 mg Tablet, Film Coated2Generic$2.00$6.00
  • QL 24 per 30 days
IBUPROFEN 600 mg Tablet, Film Coated2Generic$2.00$6.00
  • QL 15 per 30 days
IBUPROFEN 800 mg Tablet, Film Coated2Generic$2.00$6.00
  • QL 12 per 30 days
ICATIBANT 10 mg/mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
ICLEVIA KitLevonorgestrel And Ethinyl Estradiol4Non-Preferred Drug40%40%None
ICLUSIG 10 mg Tablet, Film CoatedPonatinib Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
ICLUSIG 15 mg Tablet, Film CoatedPonatinib Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
ICLUSIG 30 mg Tablet, Film CoatedPonatinib Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
ICLUSIG 45 mg Tablet, Film CoatedPonatinib Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IDHIFA 100 mg Tablet, Film CoatedEnasidenib Mesylate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IDHIFA 50 mg Tablet, Film CoatedEnasidenib Mesylate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IMATINIB MESYLATE 100 mg Tablet, Film Coated4Non-Preferred Drug40%40%
  • PA
  • QL 9 per 30 days
IMATINIB MESYLATE 400 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
IMBRUVICA 140 mg CapsuleIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
IMBRUVICA 140 mg Tablet, Film CoatedIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IMBRUVICA 280 mg Tablet, Film CoatedIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IMBRUVICA 420 mg Tablet, Film CoatedIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IMBRUVICA 70 mg CapsuleIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
IMBRUVICA 70 mg/mL SuspensionIbrutinib5Specialty Tier25%N/A
  • PA
  • QL 324 per 30 days
IMIPENEM AND CILASTATIN 250/250 mg/20mL Injection, Powder, For SolutionImipenem And Cilastatin Sodium4Non-Preferred Drug40%40%None
IMIPENEM AND CILASTATIN 500/500 mg/20mL Injection, Powder, For SolutionImipenem And Cilastatin Sodium4Non-Preferred Drug40%40%None
IMIPRAMINE HYDROCHLORIDE 10 mg Tablet4Non-Preferred Drug40%40%None
IMIQUIMOD 12.5 mg/.25g Cream3Preferred Brand18%18%
  • PA
IMKELDI 80 mg/mL SolutionImatinib Oral5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
IMOVAX RABIES KitRabies Virus Strain Pm-1503-3M Antigen (Propiolactone Inactivated) And Water1Preferred Generic$0.00$0.00
  • PA
INBRIJA 42 mg CapsuleLevodopa5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INCASSIA .35 mg TabletNorethindrone3Preferred Brand18%18%None
INCRELEX 40 mg/4mL Injection, SolutionMecasermin5Specialty Tier25%N/ANone
INCRUSE ELLIPTA 62.5 ug Aerosol, PowderUmeclidinium3Preferred Brand18%18%
  • QL 3 per 30 days
INDAPAMIDE 1.25 mg Tablet, Film Coated2Generic$2.00$6.00None
INDAPAMIDE 2.5 mg Tablet, Film Coated2Generic$2.00$6.00None
INFANRIX 10/25/25/25/8 [iU]/.5mL/ug/.5mL SuspensionDiphtheria And Tetanus Toxoids And Acellular Pertussis Vaccine Adsorbed1Preferred Generic$0.00$0.00None
INGREZZA 40 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INGREZZA 60 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INGREZZA 80 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INGREZZA KitValbenazine5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
INGREZZA SPRINKLE 40 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INGREZZA SPRINKLE 60 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INGREZZA SPRINKLE 80 mg CapsuleValbenazine5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
INLURIYO 200 mg Tablet, Film CoatedImlunestrant5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
INLYTA 1 mg Tablet, Film CoatedAxitinib5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
INLYTA 5 mg Tablet, Film CoatedAxitinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
INQOVI 100/35 mg Tablet, Film CoatedCedazuridine And Decitabine5Specialty Tier25%N/A
  • PA
  • QL 5 per 28 days
INREBIC 100 mg CapsuleFedratinib Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
INTELENCE 25 mg TabletEtravirine4Non-Preferred Drug40%40%
  • QL 12 per 30 days
INTRALIPID 20 g/100mL EmulsionI.V. Fat Emulsion4Non-Preferred Drug40%40%
  • PA
INTROVALE KitLevonorgestrel And Ethinyl Estradiol4Non-Preferred Drug40%40%None
INVEGA HAFYERA 1092 mg/3.5mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 3.5 per 180 days
INVEGA HAFYERA 1560 mg/5mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 5 per 180 days
INVEGA SUSTENNA 117 mg/.75mL InjectionPaliperidone Palmitate5Specialty Tier25%N/A
  • QL 0.75 per 28 days
INVEGA SUSTENNA 156 mg/mL InjectionPaliperidone Palmitate5Specialty Tier25%N/A
  • QL 1 per 28 days
INVEGA SUSTENNA 234 mg/1.5mL InjectionPaliperidone Palmitate5Specialty Tier25%N/A
  • QL 1.5 per 28 days
INVEGA SUSTENNA 39 mg/.25mL InjectionPaliperidone Palmitate4Non-Preferred Drug40%40%
  • QL 0.25 per 28 days
INVEGA SUSTENNA 78 mg/.5mL InjectionPaliperidone Palmitate5Specialty Tier25%N/A
  • QL 0.5 per 28 days
INVEGA TRINZA 273 mg/.88mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 0.88 per 84 days
INVEGA TRINZA 410 mg/1.32mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 1.32 per 84 days
INVEGA TRINZA 546 mg/1.75mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 1.75 per 84 days
INVEGA TRINZA 819 mg/2.63mL Injection, Suspension, Extended ReleasePaliperidone Palmitate5Specialty Tier25%N/A
  • QL 2.63 per 84 days
IPOL 40/8/32 [D'ag'U]/.5mL Injection, SuspensionPoliovirus Type 1 Antigen (Formaldehyde Inactivated), Poliovirus Type 2 Antigen (Formaldehyde Inactivated), And Poliovirus Type 3 Antigen (Formaldehyde Inactivated)1Preferred Generic$0.00$0.00None
IPRATROPIUM BROMIDE .5 mg/2.5mL Solution2Generic$2.00$6.00
  • PA
IPRATROPIUM BROMIDE 21 ug Spray, Metered2Generic$2.00$6.00
  • QL 6 per 30 days
IPRATROPIUM BROMIDE 42 ug Spray, Metered2Generic$2.00$6.00
  • QL 45 per 30 days
IPRATROPIUM BROMIDE AND ALBUTEROL SULFATE 2.5/.5 mg/3mL Solution2Generic$2.00$6.00
  • PA
IRBESARTAN 150 mg Tablet2Generic$2.00$6.00
  • QL 3 per 30 days
IRBESARTAN 300 mg Tablet2Generic$2.00$6.00
  • QL 3 per 30 days
IRBESARTAN 75 mg Tablet2Generic$2.00$6.00
  • QL 3 per 30 days
IRBESARTAN AND HYDROCHLOROTHIAZIDE 150/12.5 mg Tablet2Generic$2.00$6.00
  • QL 3 per 30 days
IRBESARTAN AND HYDROCHLOROTHIAZIDE 300/12.5 mg Tablet2Generic$2.00$6.00
  • QL 3 per 30 days
ISENTRESS 100 mg Granule, For SuspensionRaltegravir5Specialty Tier25%N/A
  • QL 6 per 30 days
ISENTRESS 100 mg Tablet, ChewableRaltegravir4Non-Preferred Drug40%40%
  • QL 18 per 30 days
ISENTRESS 25 mg Tablet, ChewableRaltegravir4Non-Preferred Drug40%40%
  • QL 18 per 30 days
ISENTRESS 400 mg Tablet, Film CoatedRaltegravir5Specialty Tier25%N/A
  • QL 6 per 30 days
ISENTRESS 600 mg Tablet, Film CoatedRaltegravir5Specialty Tier25%N/A
  • QL 6 per 30 days
ISIBLOOM KitDesogestrel And Ethinyl Estradiol4Non-Preferred Drug40%40%None
ISONIAZID 100 mg Tablet2Generic$2.00$6.00None
ISONIAZID 300 mg Tablet2Generic$2.00$6.00None
ISOSORBIDE DINITRATE 10 mg Tablet3Preferred Brand18%18%None
ISOSORBIDE DINITRATE 20 mg Tablet3Preferred Brand18%18%None
ISOSORBIDE DINITRATE 30 mg Tablet3Preferred Brand18%18%None
ISOSORBIDE DINITRATE 5 mg Tablet3Preferred Brand18%18%None
ISOSORBIDE MONONITRATE 10 mg Tablet2Generic$2.00$6.00None
ISOSORBIDE MONONITRATE 120 mg Tablet, Extended Release2Generic$2.00$6.00None
ISOSORBIDE MONONITRATE 20 mg Tablet2Generic$2.00$6.00None
ISOSORBIDE MONONITRATE 30 mg Tablet, Extended Release2Generic$2.00$6.00None
ISOSORBIDE MONONITRATE 60 mg Tablet, Extended Release2Generic$2.00$6.00None
ISOTRETINOIN 10 mg Capsule, Liquid Filled4Non-Preferred Drug40%40%
  • PA
ISOTRETINOIN 20 mg Capsule, Liquid Filled4Non-Preferred Drug40%40%
  • PA
ISOTRETINOIN 30 mg Capsule, Liquid Filled4Non-Preferred Drug40%40%
  • PA
ISOTRETINOIN 40 mg Capsule, Liquid Filled4Non-Preferred Drug40%40%
  • PA
ITOVEBI 3 mg Tablet, Film CoatedInavolisib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
ITOVEBI 9 mg Tablet, Film CoatedInavolisib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
ITRACONAZOLE 100 mg Capsule, Coated Pellets4Non-Preferred Drug40%40%
  • QL 12 per 30 days
IVABRADINE 5 mg Tablet, Film Coated4Non-Preferred Drug40%40%
  • PA
  • QL 6 per 30 days
IVABRADINE 7.5 mg Tablet, Film Coated4Non-Preferred Drug40%40%
  • PA
  • QL 6 per 30 days
IVERMECTIN 3 mg Tablet3Preferred Brand18%18%
  • PA
IWILFIN 250 mg TabletEflornithine Hydrochloride5Specialty Tier25%N/A
  • PA
  • QL 24 per 30 days
IXIARO 6 [arb'U]/.5mL Injection, SuspensionJapanese Encephalitis Vaccine, Inactivated, Adsorbed1Preferred Generic$0.00$0.00None

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.