2026 HealthSpring Assurance Rx (PDP) formulary (drug list)
Contract S5617, plan 103 · Louisiana · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 21 plan.
49 drugs starting with J.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| JAIMIESS KitLevonorgestrel And Ethinyl Estradiol And Ethinyl Estradiol Tablets | 4Non-Preferred Drug | 30% | 30% | None |
| JAKAFI 10 mg TabletRuxolitinib | 5Specialty Tier | 25% | N/A |
|
| JAKAFI 15 mg TabletRuxolitinib | 5Specialty Tier | 25% | N/A |
|
| JAKAFI 20 mg TabletRuxolitinib | 5Specialty Tier | 25% | N/A |
|
| JAKAFI 25 mg TabletRuxolitinib | 5Specialty Tier | 25% | N/A |
|
| JAKAFI 5 mg TabletRuxolitinib | 5Specialty Tier | 25% | N/A |
|
| JANTOVEN 1 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 10 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 2 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 2.5 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 3 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 4 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 5 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 6 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANTOVEN 7.5 mg TabletWarfarin Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| JANUMET 50/1000 mg Tablet, Film CoatedSitagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JANUMET 50/500 mg Tablet, Film CoatedSitagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JANUMET XR 100/1000 mg Tablet, Film Coated, Extended ReleaseSitagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JANUMET XR 50/1000 mg Tablet, Film Coated, Extended ReleaseSitagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JANUMET XR 50/500 mg Tablet, Film Coated, Extended ReleaseSitagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JANUVIA 100 mg Tablet, Film CoatedSitagliptin | 3Preferred Brand | 20% | 20% |
|
| JANUVIA 25 mg Tablet, Film CoatedSitagliptin | 3Preferred Brand | 20% | 20% |
|
| JANUVIA 50 mg Tablet, Film CoatedSitagliptin | 3Preferred Brand | 20% | 20% |
|
| JARDIANCE 10 mg Tablet, Film CoatedEmpagliflozin | 3Preferred Brand | 20% | 20% |
|
| JARDIANCE 25 mg Tablet, Film CoatedEmpagliflozin | 3Preferred Brand | 20% | 20% |
|
| JASCAYD 18 mg Tablet, Film CoatedNerandomilast | 5Specialty Tier | 25% | N/A |
|
| JASCAYD 9 mg Tablet, Film CoatedNerandomilast | 5Specialty Tier | 25% | N/A |
|
| JASMIEL KitDrospirenone And Ethinyl Estradiol | 4Non-Preferred Drug | 30% | 30% | None |
| JAYPIRCA 100 mg Tablet, CoatedPirtobrutinib | 5Specialty Tier | 25% | N/A |
|
| JAYPIRCA 50 mg Tablet, CoatedPirtobrutinib | 5Specialty Tier | 25% | N/A |
|
| JENTADUETO 2.5/1000 mg Tablet, Film CoatedLinagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JENTADUETO 2.5/500 mg Tablet, Film CoatedLinagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JENTADUETO XR 2.5/1000 mg Tablet, Film Coated, Extended ReleaseLinagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JENTADUETO XR 5/1000 mg Tablet, Film Coated, Extended ReleaseLinagliptin And Metformin Hydrochloride | 3Preferred Brand | 20% | 20% |
|
| JOYEAUX KitLevonorgestrel And Ethinyl Estradiol And Ferrous Fumarate | 4Non-Preferred Drug | 30% | 30% | None |
| JULEBER KitDesogestrel And Ethinyl Estradiol | 4Non-Preferred Drug | 30% | 30% | None |
| JULUCA 50/25 mg Tablet, Film CoatedDolutegravir Sodium And Rilpivirine Hydrochloride | 5Specialty Tier | 25% | N/A | None |
| JUNEL 21 DAY 1.5/30 mg/ug TabletNorethindrone Acetate And Ethinyl Estradiol | 4Non-Preferred Drug | 30% | 30% | None |
| JUNEL 21 DAY 1/20 mg/ug TabletNorethindrone Acetate And Ethinyl Estradiol | 4Non-Preferred Drug | 30% | 30% | None |
| JUNEL FE 24 KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate | 4Non-Preferred Drug | 30% | 30% | None |
| JUNEL FE 28 DAY KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate | 4Non-Preferred Drug | 30% | 30% | None |
| JUNEL FE 28 DAY KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate | 4Non-Preferred Drug | 30% | 30% | None |
| JYLAMVO 2 mg/mL SolutionMethotrexate | 4Non-Preferred Drug | 30% | 30% | None |
| JYNARQUE KitTolvaptan | 5Specialty Tier | 25% | N/A |
|
| JYNARQUE KitTolvaptan | 5Specialty Tier | 25% | N/A |
|
| JYNARQUE KitTolvaptan | 5Specialty Tier | 25% | N/A |
|
| JYNARQUE KitTolvaptan | 5Specialty Tier | 25% | N/A |
|
| JYNARQUE KitTolvaptan | 5Specialty Tier | 25% | N/A |
|
| JYNNEOS 50000000 1/.5mL Injection, SuspensionVaccinia Virus Modified Strain Ankara-Bavarian Nordic Non-Replicating Antigen | 3Preferred Brand | 20% | 20% | None |
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.