MedicarePartD.guide

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

Contract S5584, plan 002 · Michigan · 3,017 drugs on file · formulary ID 00026449. Each drug links to its cost in every CMS PDP Region 13 plan.

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133 drugs starting with E.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
EBGLYSS 250 mg/2mL Injection, SolutionLebrikizumab-Lbkz5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
EBGLYSS 250 mg/2mL Injection, SolutionLebrikizumab-Lbkz5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
ECONAZOLE NITRATE 10 mg/g Cream2Generic$5.00$10.00
  • QL 255 per 90 days
EDURANT 25 mg Tablet, Film CoatedRilpivirine Hydrochloride5Specialty Tier33%N/ANone
EDURANT PED 2.5 mg Tablet, For SuspensionRilpivirine Hydrochloride5Specialty Tier33%N/ANone
EFAVIRENZ 600 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 600/200/300 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 400/300/300 mg Tablet, Film Coated5Specialty Tier33%N/ANone
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 600/300/300 mg Tablet, Film Coated5Specialty Tier33%N/ANone
ELIQUIS 2.5 mg Tablet, Film CoatedApixaban3Preferred Brand24%24%
  • QL 18 per 90 days
ELIQUIS 30-DAY STARTER PACK KitApixaban3Preferred Brand24%24%
  • QL 148 per 365 days
ELIQUIS 5 mg Tablet, Film CoatedApixaban3Preferred Brand24%24%
  • QL 194 per 90 days
ELTROMBOPAG 12.5 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier33%N/A
  • PA
  • QL 62 per 31 days
ELTROMBOPAG 12.5 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
  • QL 31 per 31 days
ELTROMBOPAG 25 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier33%N/A
  • PA
  • QL 186 per 31 days
ELTROMBOPAG 25 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
  • QL 31 per 31 days
ELTROMBOPAG 50 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
  • QL 62 per 31 days
ELTROMBOPAG 75 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
  • QL 62 per 31 days
ELURYNG .12/.015 mg/d RingEtonogestrel And Ethinyl Estradiol3Preferred Brand24%24%
  • QL 3 per 84 days
EMGALITY 100 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand24%24%
  • PA
  • QL 9 per 84 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand24%24%
  • PA
  • QL 6 per 84 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand24%24%
  • PA
  • QL 6 per 84 days
EMSAM 12 mg/24h PatchSelegiline5Specialty Tier33%N/A
  • PA
  • QL 31 per 31 days
EMSAM 6 mg/24h PatchSelegiline5Specialty Tier33%N/A
  • PA
  • QL 31 per 31 days
EMSAM 9 mg/24h PatchSelegiline5Specialty Tier33%N/A
  • PA
  • QL 31 per 31 days
EMTRICITABINE 200 mg Capsule4Non-Preferred Drug27%27%None
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 100/150 mg Tablet, Film Coated4Non-Preferred Drug27%27%
  • QL 31 per 31 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 133/200 mg Tablet, Film Coated5Specialty Tier33%N/A
  • QL 31 per 31 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 167/250 mg Tablet, Film Coated4Non-Preferred Drug27%27%
  • QL 31 per 31 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 200/300 mg Tablet, Film Coated3Preferred Brand24%24%
  • QL 31 per 31 days
EMTRICITABINE, RILPIVIRINE, TENOFOVIR DISOPROXIL FUMARATE 200/25/300 mg Tablet, Film Coated5Specialty Tier33%N/ANone
EMTRIVA 10 mg/mL SolutionEmtricitabine4Non-Preferred Drug27%27%None
ENALAPRIL MALEATE 10 mg Tablet1Preferred Generic$1.00$2.00
  • QL 36 per 90 days
ENALAPRIL MALEATE 2.5 mg Tablet1Preferred Generic$1.00$2.00
  • QL 144 per 90 days
ENALAPRIL MALEATE 20 mg Tablet1Preferred Generic$1.00$2.00
  • QL 18 per 90 days
ENALAPRIL MALEATE 5 mg Tablet1Preferred Generic$1.00$2.00
  • QL 72 per 90 days
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 10/25 mg Tablet1Preferred Generic$1.00$2.00
  • QL 18 per 90 days
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 5/12.5 mg Tablet1Preferred Generic$1.00$2.00
  • QL 36 per 90 days
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier33%N/A
  • PA
  • QL 16 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier33%N/A
  • PA
  • QL 8 per 28 days
ENGERIX-B 10 ug/.5mL Injection, SuspensionHepatitis B Vaccine (Recombinant)3Preferred Brand24%24%
  • PA
ENGERIX-B 20 ug/mL Injection, SuspensionHepatitis B Vaccine (Recombinant)3Preferred Brand24%24%
  • PA
ENILLORING .015/.12 mg/d RingEtonogestrel And Ethinyl Estradiol Vaginal3Preferred Brand24%24%
  • QL 3 per 84 days
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug27%27%None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug27%27%None
ENSACOVE 100 mg CapsuleEnsartinib5Specialty Tier33%N/A
  • PA
ENSACOVE 25 mg CapsuleEnsartinib5Specialty Tier33%N/A
  • PA
ENTACAPONE 200 mg Tablet4Non-Preferred Drug27%27%None
ENTECAVIR .5 mg Tablet4Non-Preferred Drug27%27%
  • QL 9 per 90 days
ENTECAVIR 1 mg Tablet4Non-Preferred Drug27%27%
  • QL 9 per 90 days
ENTRESTO 15/16 mg PelletSacubitril And Valsartan3Preferred Brand24%24%
  • QL 72 per 90 days
ENTRESTO 6/6 mg PelletSacubitril And Valsartan3Preferred Brand24%24%
  • QL 72 per 90 days
ENULOSE 10 g/15mL SolutionLactulose2Generic$5.00$10.00None
EPIDIOLEX 100 mg/mL SolutionCannabidiol5Specialty Tier33%N/A
  • PA
  • QL 6 per 30 days
EPINEPHRINE .15 mg/.15mL Injection3Preferred Brand24%24%
  • QL 6 per 90 days
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand24%24%
  • QL 6 per 90 days
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand24%24%
  • QL 6 per 90 days
EPLERENONE 25 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
EPLERENONE 50 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
ERIVEDGE 150 mg CapsuleVismodegib5Specialty Tier33%N/A
  • PA
ERLEADA 240 mg Tablet, Film CoatedApalutamide5Specialty Tier33%N/A
  • PA
ERLEADA 60 mg Tablet, Film CoatedApalutamide5Specialty Tier33%N/A
  • PA
ERLOTINIB 100 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
ERLOTINIB 150 mg Tablet, Film Coated5Specialty Tier33%N/A
  • PA
ERLOTINIB 25 mg Tablet5Specialty Tier33%N/A
  • PA
ERTAPENEM 1 g/20mL InjectionErtapenem Sodium4Non-Preferred Drug27%27%None
ERYTHROMYCIN 20 mg/mL Solution3Preferred Brand24%24%
  • QL 18 per 90 days
ERYTHROMYCIN 250 mg Capsule, Delayed Release Pellets4Non-Preferred Drug27%27%None
ERYTHROMYCIN 250 mg Tablet, Coated4Non-Preferred Drug27%27%None
ERYTHROMYCIN 250 mg Tablet, Delayed Release4Non-Preferred Drug27%27%None
ERYTHROMYCIN 333 mg Tablet, Delayed Release4Non-Preferred Drug27%27%None
ERYTHROMYCIN 5 mg/g Ointment2Generic$5.00$10.00None
ERYTHROMYCIN 500 mg Tablet, Coated4Non-Preferred Drug27%27%None
ESCITALOPRAM 10 mg Tablet, Film Coated2Generic$5.00$10.00
  • QL 18 per 90 days
ESCITALOPRAM 20 mg Tablet, Film Coated2Generic$5.00$10.00
  • QL 9 per 90 days
ESCITALOPRAM 5 mg Tablet, Film Coated2Generic$5.00$10.00
  • QL 36 per 90 days
ESCITALOPRAM OXALATE 5 mg/5mL SolutionEscitalopram4Non-Preferred Drug27%27%
  • QL 18 per 90 days
ESLICARBAZEPINE ACETATE 200 mg Tablet4Non-Preferred Drug27%27%
  • QL 62 per 31 days
ESLICARBAZEPINE ACETATE 400 mg Tablet4Non-Preferred Drug27%27%
  • QL 62 per 31 days
ESLICARBAZEPINE ACETATE 600 mg Tablet4Non-Preferred Drug27%27%
  • QL 62 per 31 days
ESLICARBAZEPINE ACETATE 800 mg Tablet4Non-Preferred Drug27%27%
  • QL 62 per 31 days
ESOMEPRAZOLE MAGNESIUM 20 mg Capsule, Delayed Release2Generic$5.00$10.00
  • QL 18 per 90 days
ESOMEPRAZOLE MAGNESIUM 40 mg Capsule, Delayed Release2Generic$5.00$10.00
  • QL 18 per 90 days
ESTRADIOL .5 mg Tablet2Generic$5.00$10.00None
ESTRADIOL 1 mg Tablet2Generic$5.00$10.00None
ESTRADIOL 10 ug Insert4Non-Preferred Drug27%27%None
ESTRADIOL 2 mg Tablet2Generic$5.00$10.00None
ESTRADIOL VAGINAL .1 mg/g CreamEstradiol4Non-Preferred Drug27%27%None
ESTRADIOL VALERATE 10 mg/mL Injection4Non-Preferred Drug27%27%None
ESTRADIOL VALERATE 20 mg/mL Injection, Solution4Non-Preferred Drug27%27%None
ETHAMBUTOL HYDROCHLORIDE 100 mg Tablet3Preferred Brand24%24%None
ETHAMBUTOL HYDROCHLORIDE 400 mg Tablet3Preferred Brand24%24%None
ETHOSUXIMIDE 250 mg/5mL Solution4Non-Preferred Drug27%27%None
ETODOLAC 200 mg Capsule2Generic$5.00$10.00None
ETODOLAC 300 mg Capsule2Generic$5.00$10.00None
ETODOLAC 400 mg Tablet, Film Coated2Generic$5.00$10.00None
ETODOLAC 500 mg Tablet, Film Coated2Generic$5.00$10.00None
ETONOGESTREL/ETHINYL ESTRADIOL .12/.015 mg/d Insert, Extended ReleaseEtonogestrel And Ethinyl Estradiol3Preferred Brand24%24%
  • QL 3 per 84 days
ETRAVIRINE 100 mg Tablet5Specialty Tier33%N/ANone
ETRAVIRINE 200 mg Tablet5Specialty Tier33%N/ANone
EUCRISA 20 mg/g OintmentCrisaborole4Non-Preferred Drug27%27%
  • PA
  • QL 3 per 90 days
EULEXIN 125 mg CapsuleFlutamide5Specialty Tier33%N/A
  • PA
EVEROLIMUS .25 mg Tablet4Non-Preferred Drug27%27%
  • PA
EVEROLIMUS .5 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS .75 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS 1 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS 10 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS 2 mg Tablet, For Suspension5Specialty Tier33%N/A
  • PA
EVEROLIMUS 2.5 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS 3 mg Tablet, For Suspension5Specialty Tier33%N/A
  • PA
EVEROLIMUS 5 mg Tablet5Specialty Tier33%N/A
  • PA
EVEROLIMUS 5 mg Tablet, For Suspension5Specialty Tier33%N/A
  • PA
EVEROLIMUS 7.5 mg Tablet5Specialty Tier33%N/A
  • PA
EVOTAZ 300/150 mg TabletAtazanavir And Cobicistat5Specialty Tier33%N/ANone
EXEMESTANE 25 mg Tablet4Non-Preferred Drug27%27%None
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone5Specialty Tier33%N/A
  • ST
  • QL 31 per 31 days
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone5Specialty Tier33%N/A
  • ST
  • QL 32 per 14 days
EXXUA 36.3 mg Tablet, Extended ReleaseGepirone5Specialty Tier33%N/A
  • ST
  • QL 31 per 31 days
EXXUA 54.5 mg Tablet, Extended ReleaseGepirone5Specialty Tier33%N/A
  • ST
  • QL 31 per 31 days
EXXUA 72.6 mg Tablet, Extended ReleaseGepirone5Specialty Tier33%N/A
  • ST
  • QL 31 per 31 days
EZETIMIBE 10 mg Tablet3Preferred Brand24%24%
  • QL 9 per 90 days
EZETIMIBE AND SIMVASTATIN 10/10 mg Tablet4Non-Preferred Drug27%27%
  • QL 9 per 90 days
EZETIMIBE AND SIMVASTATIN 10/20 mg Tablet4Non-Preferred Drug27%27%
  • QL 9 per 90 days
EZETIMIBE AND SIMVASTATIN 10/40 mg Tablet4Non-Preferred Drug27%27%
  • QL 9 per 90 days
EZETIMIBE AND SIMVASTATIN 10/80 mg Tablet4Non-Preferred Drug27%27%
  • 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.