2026 Prescription Blue Select (PDP) formulary (drug list)

Contract S5584, plan 001 · Michigan · 3,017 drugs on file · formulary ID 00026449. Each drug links to its cost in every CMS PDP Region 13 plan.

169 drugs starting with M.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
M-M-R II 1000/12500/1000 [TCID_50]/.5mL Injection, Powder, Lyophilized, For SuspensionMeasles, Mumps, And Rubella Virus Vaccine Live	3Preferred Brand	20%	20%	None
MALATHION .0005 g/mL Lotion	4Non-Preferred Drug	25%	25%	None
MARAVIROC 150 mg Tablet, Film Coated	5Specialty Tier	25%	N/A	None
MARAVIROC 300 mg Tablet, Film Coated	5Specialty Tier	25%	N/A	None
MATULANE 50 mg CapsuleProcarbazine Hydrochloride	5Specialty Tier	25%	N/A	None
MAVYRET 40/100 mg Tablet, Film CoatedGlecaprevir And Pibrentasvir	5Specialty Tier	25%	N/A	PA QL 84 per 28 days
MECLIZINE HYDROCHLORIDE 12.5 mg TabletMeclizine	2Generic	$5.00	$15.00	None
MECLIZINE HYDROCHLORIDE 25 mg Tablet	2Generic	$5.00	$15.00	None
MEDROXYPROGESTERONE ACETATE 10 mg Tablet	2Generic	$5.00	$15.00	None
MEDROXYPROGESTERONE ACETATE 150 mg/mL Injection, Suspension	3Preferred Brand	20%	20%	None
MEDROXYPROGESTERONE ACETATE 150 mg/mL Injection, Suspension	3Preferred Brand	20%	20%	None
MEDROXYPROGESTERONE ACETATE 2.5 mg Tablet	2Generic	$5.00	$15.00	None
MEDROXYPROGESTERONE ACETATE 5 mg Tablet	2Generic	$5.00	$15.00	None
MEFLOQUINE HYDROCHLORIDE 250 mg Tablet	2Generic	$5.00	$15.00	None
MEGESTROL ACETATE 125 mg/mL Suspension	4Non-Preferred Drug	25%	25%	None
MEGESTROL ACETATE 20 mg Tablet	3Preferred Brand	20%	20%	None
MEGESTROL ACETATE 40 mg Tablet	3Preferred Brand	20%	20%	None
MEGESTROL ACETATE 40 mg/mL Suspension	4Non-Preferred Drug	25%	25%	None
MEKINIST .05 mg/mL Powder, For SolutionTrametinib	5Specialty Tier	25%	N/A	PA
MEKINIST .5 mg Tablet, Film CoatedTrametinib	5Specialty Tier	25%	N/A	PA
MEKINIST 2 mg Tablet, Film CoatedTrametinib	5Specialty Tier	25%	N/A	PA
MEKTOVI 15 mg Tablet, Film CoatedBinimetinib	5Specialty Tier	25%	N/A	PA
MELOXICAM 15 mg Tablet	2Generic	$5.00	$15.00	None
MELOXICAM 7.5 mg Tablet	2Generic	$5.00	$15.00	None
MEMANTINE 2 mg/mL SolutionMemantine Hydrochloride	4Non-Preferred Drug	25%	25%	PA QL 108 per 90 days
MEMANTINE AND DONEPEZIL HYDROCHLORIDES 21/10 mg Capsule, Extended Release	3Preferred Brand	20%	20%	None
MEMANTINE AND DONEPEZIL HYDROCHLORIDES EXTENDED-RELEASE 14/10 mg Capsule, Extended ReleaseMemantine And Donepezil	3Preferred Brand	20%	20%	None
MEMANTINE AND DONEPEZIL HYDROCHLORIDES EXTENDED-RELEASE 28/10 mg Capsule, Extended ReleaseMemantine And Donepezil	3Preferred Brand	20%	20%	None
MEMANTINE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	20%	20%	PA QL 18 per 90 days
MEMANTINE HYDROCHLORIDE 14 mg Capsule, Extended Release	4Non-Preferred Drug	25%	25%	PA QL 9 per 90 days
MEMANTINE HYDROCHLORIDE 21 mg Capsule, Extended Release	4Non-Preferred Drug	25%	25%	PA QL 9 per 90 days
MEMANTINE HYDROCHLORIDE 28 mg Capsule, Extended Release	4Non-Preferred Drug	25%	25%	PA QL 9 per 90 days
MEMANTINE HYDROCHLORIDE 5 mg Tablet, Film Coated	3Preferred Brand	20%	20%	PA QL 18 per 90 days
MEMANTINE HYDROCHLORIDE 7 mg Capsule, Extended Release	4Non-Preferred Drug	25%	25%	PA QL 9 per 90 days
MEMANTINE HYDROCHLORIDE Kit	3Preferred Brand	20%	20%	PA QL 98 per 365 days
MENQUADFI 10/10/10/10 ug/.5mL Injection, SolutionNeisseria Meningitidis Group A Capsular Polysaccharide Tetanus Toxoid Conjugate Antigen, Neisseria Meningitidis Group C Capsular Polysaccharide Tetanus Toxoid Conjugate Antigen, Neisseria Meningitidis Group Y Capsular Polysaccharide Tetanus Toxoid Conjugate Antigen, And Neisseria Meningitidis Group W-135 Capsular Polysaccharide Tetanus Toxoid Conjugate Antigen	3Preferred Brand	20%	20%	None
MENVEO KitMeningococcal (Groups A, C, Y And W-135) Oligosaccharide Diphtheria Crm197 Conjugate Vaccine	3Preferred Brand	20%	20%	None
MERCAPTOPURINE 20 mg/mL Suspension	5Specialty Tier	25%	N/A	None
MERCAPTOPURINE 50 mg Tablet	3Preferred Brand	20%	20%	None
MEROPENEM 1 g Injection, Powder, For Solution	3Preferred Brand	20%	20%	None
MEROPENEM 500 mg Injection, Powder, For Solution	3Preferred Brand	20%	20%	None
MESALAMINE .375 g Capsule, Extended Release	4Non-Preferred Drug	25%	25%	QL 36 per 90 days
MESALAMINE 1.2 g Tablet, Delayed Release	4Non-Preferred Drug	25%	25%	QL 36 per 90 days
MESALAMINE 1000 mg Suppository	4Non-Preferred Drug	25%	25%	QL 9 per 90 days
MESALAMINE 4 g/60mL Enema	4Non-Preferred Drug	25%	25%	QL 54 per 90 days
MESALAMINE 400 mg Capsule, Delayed Release	4Non-Preferred Drug	25%	25%	QL 108 per 90 days
MESALAMINE 800 mg Tablet, Delayed Release	4Non-Preferred Drug	25%	25%	QL 54 per 90 days
MESNA 400 mg Tablet, Film Coated	5Specialty Tier	25%	N/A	None
METFORMIN 500 mg Tablet, Extended ReleaseMetformin Er 500 Mg	1Preferred Generic	$1.00	$3.00	QL 36 per 90 days
METFORMIN HYDROCHLORIDE 500 mg Tablet	1Preferred Generic	$1.00	$3.00	QL 45 per 90 days
METFORMIN HYDROCHLORIDE 750 mg Tablet, Extended Release	1Preferred Generic	$1.00	$3.00	QL 18 per 90 days
METFORMIN HYDROCHLORIDE 850 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	QL 27 per 90 days
METHADONE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	20%	20%	QL 372 per 31 days
METHADONE HYDROCHLORIDE 10 mg/5mL Solution	3Preferred Brand	20%	20%	QL 186 per 31 days
METHADONE HYDROCHLORIDE 5 mg Tablet	3Preferred Brand	20%	20%	QL 496 per 31 days
METHADONE HYDROCHLORIDE 5 mg/5mL Solution	3Preferred Brand	20%	20%	QL 372 per 31 days
METHAZOLAMIDE 25 mg Tablet	4Non-Preferred Drug	25%	25%	None
METHAZOLAMIDE 50 mg Tablet	4Non-Preferred Drug	25%	25%	None
METHENAMINE HIPPURATE 1 g Tablet	4Non-Preferred Drug	25%	25%	None
METHIMAZOLE 10 mg Tablet	2Generic	$5.00	$15.00	None
METHIMAZOLE 5 mg Tablet	2Generic	$5.00	$15.00	None
METHOCARBAMOL 500 mg Tablet, CoatedMethocarbamol Tablets	2Generic	$5.00	$15.00	None
METHOCARBAMOL 750 mg Tablet, CoatedMethocarbamol Tablets	2Generic	$5.00	$15.00	None
METHOTREXATE 2.5 mg Tablet	4Non-Preferred Drug	25%	25%	None
METHOTREXATE 25 mg/mL Injection, Solution	3Preferred Brand	20%	20%	None
METHOTREXATE 25 mg/mL Solution	3Preferred Brand	20%	20%	None
METHSUXIMIDE 300 mg Capsule	3Preferred Brand	20%	20%	None
METHYLPHENIDATE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	20%	20%	QL 27 per 90 days
METHYLPHENIDATE HYDROCHLORIDE 10 mg/5mL Solution	4Non-Preferred Drug	25%	25%	QL 27 per 90 days
METHYLPHENIDATE HYDROCHLORIDE 20 mg Tablet	3Preferred Brand	20%	20%	QL 27 per 90 days
METHYLPHENIDATE HYDROCHLORIDE 5 mg Tablet	3Preferred Brand	20%	20%	QL 27 per 90 days
METHYLPHENIDATE HYDROCHLORIDE 5 mg/5mL Solution	4Non-Preferred Drug	25%	25%	QL 54 per 90 days
METHYLPREDNISOLONE 16 mg Tablet	2Generic	$5.00	$15.00	None
METHYLPREDNISOLONE 32 mg Tablet	2Generic	$5.00	$15.00	None
METHYLPREDNISOLONE 4 mg Tablet	2Generic	$5.00	$15.00	None
METHYLPREDNISOLONE 4 mg Tablet	2Generic	$5.00	$15.00	None
METHYLPREDNISOLONE 8 mg Tablet	2Generic	$5.00	$15.00	None
METOCLOPRAMIDE 10 mg Tablet	2Generic	$5.00	$15.00	None
METOCLOPRAMIDE 5 mg Tablet	2Generic	$5.00	$15.00	None
METOCLOPRAMIDE 5 mg/5mL Solution	2Generic	$5.00	$15.00	None
METOLAZONE 10 mg Tablet	3Preferred Brand	20%	20%	None
METOLAZONE 2.5 mg Tablet	3Preferred Brand	20%	20%	None
METOLAZONE 5 mg Tablet	3Preferred Brand	20%	20%	None
METOPROLOL SUCCINATE 100 mg Tablet, Film Coated, Extended Release	2Generic	$5.00	$15.00	None
METOPROLOL SUCCINATE 200 mg Tablet, Film Coated, Extended Release	2Generic	$5.00	$15.00	None
METOPROLOL SUCCINATE 25 mg Tablet, Extended Release	2Generic	$5.00	$15.00	None
METOPROLOL SUCCINATE 50 mg Tablet, Extended Release	2Generic	$5.00	$15.00	None
METOPROLOL TARTRATE 100 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	None
METOPROLOL TARTRATE 25 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	None
METOPROLOL TARTRATE 50 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	None
METOPROLOL TARTRATE AND HYDROCHLOROTHIAZIDE 100/25 mg Tablet	3Preferred Brand	20%	20%	None
METOPROLOL TARTRATE AND HYDROCHLOROTHIAZIDE 100/50 mg Tablet	3Preferred Brand	20%	20%	None
METOPROLOL TARTRATE AND HYDROCHLOROTHIAZIDE 50/25 mg Tablet	3Preferred Brand	20%	20%	None
METRONIDAZOLE 250 mg Tablet	2Generic	$5.00	$15.00	None
METRONIDAZOLE 500 mg Tablet	2Generic	$5.00	$15.00	None
METRONIDAZOLE 500 mg/100mL Injection, Solution	4Non-Preferred Drug	25%	25%	None
METRONIDAZOLE 7.5 mg/g Cream	3Preferred Brand	20%	20%	None
METRONIDAZOLE 7.5 mg/g Gel	4Non-Preferred Drug	25%	25%	None
METRONIDAZOLE VAGINAL 7.5 mg/g GelMetronidazole	4Non-Preferred Drug	25%	25%	None
METYROSINE 250 mg Capsule	5Specialty Tier	25%	N/A	None
MICAFUNGIN 100 mg Injection, Powder, Lyophilized, For SolutionMicafungin Sodium	4Non-Preferred Drug	25%	25%	None
MICAFUNGIN 50 mg Injection, Powder, Lyophilized, For SolutionMicafungin Sodium	4Non-Preferred Drug	25%	25%	None
MIDODRINE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	20%	20%	None
MIDODRINE HYDROCHLORIDE 2.5 mg Tablet	3Preferred Brand	20%	20%	None
MIDODRINE HYDROCHLORIDE 5 mg Tablet	3Preferred Brand	20%	20%	None
MIEBO 1 mg/mg SolutionPerfluorohexyloctane	4Non-Preferred Drug	25%	25%	QL 36 per 90 days
MIFEPRISTONE 300 mg Tablet, Film Coated	5Specialty Tier	25%	N/A	PA
MIGERGOT 2/100 mg SuppositoryErgotamine Tartrate And Caffeine	5Specialty Tier	25%	N/A	None
MINOCYCLINE HYDROCHLORIDE 100 mg Capsule	2Generic	$5.00	$15.00	None
MINOCYCLINE HYDROCHLORIDE 50 mg Capsule	2Generic	$5.00	$15.00	None
MINOCYCLINE HYDROCHLORIDE 75 mg Capsule	2Generic	$5.00	$15.00	None
MINOXIDIL 10 mg Tablet	2Generic	$5.00	$15.00	None
MINOXIDIL 2.5 mg Tablet	2Generic	$5.00	$15.00	None
MIRTAZAPINE 15 mg Tablet, Film Coated	2Generic	$5.00	$15.00	QL 18 per 90 days
MIRTAZAPINE 15 mg Tablet, Orally Disintegrating	3Preferred Brand	20%	20%	QL 18 per 90 days
MIRTAZAPINE 30 mg Tablet, Film Coated	2Generic	$5.00	$15.00	QL 9 per 90 days
MIRTAZAPINE 30 mg Tablet, Orally Disintegrating	3Preferred Brand	20%	20%	QL 18 per 90 days
MIRTAZAPINE 45 mg Tablet, Film Coated	2Generic	$5.00	$15.00	QL 9 per 90 days
MIRTAZAPINE 45 mg Tablet, Orally Disintegrating	3Preferred Brand	20%	20%	QL 9 per 90 days
MIRTAZAPINE 7.5 mg Tablet, Film Coated	2Generic	$5.00	$15.00	QL 18 per 90 days
MISOPROSTOL 100 ug Tablet	3Preferred Brand	20%	20%	None
MISOPROSTOL 200 ug Tablet	3Preferred Brand	20%	20%	None
MIXED SALTS OF A SINGLE ENTITY AMPHETAMINE PRODUCT XR 2.5/2.5/2.5/2.5 mg Capsule, Extended ReleaseDextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate	4Non-Preferred Drug	25%	25%	QL 18 per 90 days
MIXED SALTS OF A SINGLE ENTITY AMPHETAMINE PRODUCT XR 5/5/5/5 mg Capsule, Extended ReleaseDextroamphetamine Saccharate, Amphetamine Aspartate Monohydrate, Dextroamphetamine Sulfate, Amphetamine Sulfate	4Non-Preferred Drug	25%	25%	QL 18 per 90 days
MODAFINIL 100 mg Tablet	3Preferred Brand	20%	20%	PA QL 18 per 90 days
MODAFINIL 200 mg Tablet	3Preferred Brand	20%	20%	PA QL 18 per 90 days
MODEYSO 125 mg CapsuleDordaviprone	5Specialty Tier	25%	N/A	PA
MOEXIPRIL HYDROCHLORIDE 15 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	QL 18 per 90 days
MOEXIPRIL HYDROCHLORIDE 7.5 mg Tablet, Film Coated	1Preferred Generic	$1.00	$3.00	QL 36 per 90 days
MOLINDONE HYDROCHLORIDE 10 mg Tablet	4Non-Preferred Drug	25%	25%	None
MOLINDONE HYDROCHLORIDE 25 mg Tablet	4Non-Preferred Drug	25%	25%	None
MOLINDONE HYDROCHLORIDE 5 mg Tablet	4Non-Preferred Drug	25%	25%	None
MOMETASONE FUROATE 1 mg/g Cream	3Preferred Brand	20%	20%	None
MOMETASONE FUROATE 1 mg/g Ointment	3Preferred Brand	20%	20%	None
MOMETASONE FUROATE 1 mg/mL Solution	3Preferred Brand	20%	20%	None
MONTELUKAST SODIUM 10 mg Tablet, Film Coated	2Generic	$5.00	$15.00	QL 9 per 90 days
MONTELUKAST SODIUM 4 mg Granule	3Preferred Brand	20%	20%	QL 9 per 90 days
MONTELUKAST SODIUM 4 mg Tablet, Chewable	2Generic	$5.00	$15.00	QL 9 per 90 days
MONTELUKAST SODIUM 5 mg Tablet, Chewable	2Generic	$5.00	$15.00	QL 9 per 90 days
MORPHINE SULFATE 15 mg Tablet	3Preferred Brand	20%	20%	QL 186 per 31 days
MORPHINE SULFATE 20 mg/5mL Solution	3Preferred Brand	20%	20%	QL 155 per 31 days
MORPHINE SULFATE 20 mg/mL Solution	3Preferred Brand	20%	20%	QL 93 per 31 days
MORPHINE SULFATE 30 mg Tablet	3Preferred Brand	20%	20%	QL 186 per 31 days
MORPHINE SULFATE EXTENDED RELEASE 100 mg Tablet, Film Coated, Extended ReleaseMorphine Sulfate	4Non-Preferred Drug	25%	25%	QL 93 per 31 days
MORPHINE SULFATE EXTENDED RELEASE 15 mg Tablet, Film Coated, Extended ReleaseMorphine Sulfate	4Non-Preferred Drug	25%	25%	QL 93 per 31 days
MORPHINE SULFATE EXTENDED RELEASE 200 mg Tablet, Film Coated, Extended ReleaseMorphine Sulfate	4Non-Preferred Drug	25%	25%	QL 31 per 31 days
MORPHINE SULFATE EXTENDED RELEASE 30 mg Tablet, Film Coated, Extended ReleaseMorphine Sulfate	4Non-Preferred Drug	25%	25%	QL 93 per 31 days
MORPHINE SULFATE EXTENDED RELEASE 60 mg Tablet, Film Coated, Extended ReleaseMorphine Sulfate	4Non-Preferred Drug	25%	25%	QL 93 per 31 days
MOUNJARO 10 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOUNJARO 12.5 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOUNJARO 15 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOUNJARO 2.5 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOUNJARO 5 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOUNJARO 7.5 mg/.5mL Injection, SolutionTirzepatide	3Preferred Brand	20%	20%	PA QL 2 per 28 days
MOVANTIK 12.5 mg Tablet, Film CoatedNaloxegol Oxalate	4Non-Preferred Drug	25%	25%	PA QL 18 per 90 days
MOVANTIK 25 mg Tablet, Film CoatedNaloxegol Oxalate	4Non-Preferred Drug	25%	25%	PA QL 9 per 90 days
MOXIFLOXACIN 400 mg Tablet, Film Coated	4Non-Preferred Drug	25%	25%	None
MOXIFLOXACIN 5 mg/mL Solution/ Drops	3Preferred Brand	20%	20%	None
MOXIFLOXACIN HYDROCHLORIDE 400 mg/250mL Injection, Solution	4Non-Preferred Drug	25%	25%	None
MRESVIA 50 ug/.5mL SuspensionRespiratory Syncytial Virus Vaccine	3Preferred Brand	20%	20%	None
MULTIPLE ELECTROLYTES PH 7.4 526/502/368/37/30 mg/100mL Injection, SolutionSodium Chloride, Sodium Gluconate, Sodium Acetate, Potassium Chloride And Magnesium Chloride	4Non-Preferred Drug	25%	25%	None
MUPIROCIN 20 mg/g Ointment	3Preferred Brand	20%	20%	QL 9 per 90 days
MYCOPHENOLATE MOFETIL 200 mg/mL Powder, For Suspension	5Specialty Tier	25%	N/A	PA
MYCOPHENOLATE MOFETIL 250 mg Capsule	4Non-Preferred Drug	25%	25%	PA
MYCOPHENOLATE MOFETIL 500 mg Tablet, Film Coated	4Non-Preferred Drug	25%	25%	PA
MYCOPHENOLIC ACID 180 mg Tablet, Delayed Release	4Non-Preferred Drug	25%	25%	PA
MYCOPHENOLIC ACID 360 mg Tablet, Delayed Release	4Non-Preferred Drug	25%	25%	PA
MYRBETRIQ 25 mg Tablet, Film Coated, Extended ReleaseMirabegron	3Preferred Brand	20%	20%	QL 9 per 90 days
MYRBETRIQ 50 mg Tablet, Film Coated, Extended ReleaseMirabegron	3Preferred Brand	20%	20%	QL 9 per 90 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.