2026 HealthSpring Extra Rx (PDP) formulary (drug list)
Contract S5617, plan 363 · Michigan · 3,270 drugs on file · formulary ID 00026094. Each drug links to its cost in every CMS PDP Region 13 plan.
2 drugs starting with Y.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| YF-VAX 4.74 [PFU]/.5mL Injection, Powder, Lyophilized, For SuspensionYellow Fever Virus Strain 17D-204 Live Antigen | 3Preferred Brand | 17% | 17% | None |
| YUVAFEM 10 ug TabletEstradiol | 4Non-Preferred Drug | 32% | 32% | 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.