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2026 AARP Medicare Rx Saver from UHC (PDP) formulary (drug list)

Contract S5921, plan 363 · Missouri · 3,062 drugs on file · formulary ID 00026001. Each drug links to its cost in every CMS PDP Region 18 plan.

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202 drugs starting with L.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
L-GLUTAMINE 5 g Powder, For Solution5Specialty Tier25%N/A
  • PA
LABETALOL HYDROCHLORIDE 100 mg Tablet, Film Coated3Preferred Brand17%17%None
LABETALOL HYDROCHLORIDE 200 mg Tablet, Film Coated3Preferred Brand17%17%None
LABETALOL HYDROCHLORIDE 300 mg Tablet, Film Coated3Preferred Brand17%17%None
LABETALOL HYDROCHLORIDE 400 mg Tablet, Film Coated3Preferred Brand17%17%None
LACOSAMIDE 100 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LACOSAMIDE 150 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LACOSAMIDE 200 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LACOSAMIDE 50 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LACOSAMIDE ORAL SOLUTION 10 mg/mL Solution4Non-Preferred Drug39%N/A
  • QL 12 per 30 days
LACTULOSE 10 g/15mL Solution3Preferred Brand17%17%None
LAMIVUDINE 100 mg Tablet, Film Coated3Preferred Brand17%17%None
LAMIVUDINE 150 mg Tablet3Preferred Brand17%17%
  • QL 6 per 30 days
LAMIVUDINE 300 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
LAMIVUDINE AND ZIDOVUDINE 150/300 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LAMOTRIGINE 100 mg Tablet2Generic$8.00$24.00None
LAMOTRIGINE 150 mg Tablet2Generic$8.00$24.00None
LAMOTRIGINE 200 mg Tablet2Generic$8.00$24.00None
LAMOTRIGINE 25 mg Tablet2Generic$8.00$24.00None
LAMOTRIGINE 25 mg Tablet, Chewable3Preferred Brand17%17%None
LAMOTRIGINE 5 mg Tablet, Chewable3Preferred Brand17%17%None
LANTUS 100 [iU]/mL Injection, SolutionInsulin Glargine3Preferred Brand17%17%None
LANTUS SOLOSTAR 100 [iU]/mL Injection, SolutionInsulin Glargine3Preferred Brand17%17%None
LAPATINIB 250 mg Tablet5Specialty Tier25%N/A
  • PA
LARIN 1.5/30 KitNorethindrone Acetate/Ethinyl Estradiol3Preferred Brand17%17%None
LARIN 1/20 KitNorethindrone Acetate/Ethinyl Estradiol3Preferred Brand17%17%None
LARIN FE 1.5/30 KitNorethindrone Acetate/Ethinyl Estradiol And Ferrous Fumarate3Preferred Brand17%17%None
LARIN FE 1/20 KitNorethindrone Acetate/Ethinyl Estradiol And Ferrous Fumarate3Preferred Brand17%17%None
LATANOPROST 50 ug/mL Solution2Generic$8.00$24.00None
LAZCLUZE 240 mg Tablet, Film CoatedLazertinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LAZCLUZE 80 mg Tablet, Film CoatedLazertinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
LEFLUNOMIDE 10 mg Tablet3Preferred Brand17%17%None
LEFLUNOMIDE 20 mg Tablet3Preferred Brand17%17%None
LENALIDOMIDE 10 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENALIDOMIDE 15 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENALIDOMIDE 2.5 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENALIDOMIDE 20 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENALIDOMIDE 25 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENALIDOMIDE 5 mg Capsule5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LENVIMA 10 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA 10 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA 4 mg CapsuleLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
LENVIMA KitLenvatinib5Specialty Tier25%N/A
  • PA
LESSINA KitLevonorgestrel And Ethinyl Estradiol3Preferred Brand17%17%None
LETROZOLE 2.5 mg Tablet2Generic$8.00$24.00None
LEUCOVORIN CALCIUM 10 mg Tablet3Preferred Brand17%17%None
LEUCOVORIN CALCIUM 15 mg Tablet3Preferred Brand17%17%None
LEUCOVORIN CALCIUM 25 mg Tablet4Non-Preferred Drug39%N/ANone
LEUCOVORIN CALCIUM 5 mg Tablet3Preferred Brand17%17%None
LEUKERAN 2 mg Tablet, Film CoatedChlorambucil4Non-Preferred Drug39%N/ANone
LEUPROLIDE ACETATE Kit4Non-Preferred Drug39%N/A
  • PA
  • QL 2 per 28 days
LEVETIRACETAM 100 mg/mL SolutionLevetiracetam Oral3Preferred Brand17%17%None
LEVETIRACETAM 1000 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVETIRACETAM 250 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVETIRACETAM 250 mg Tablet, For Suspension4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LEVETIRACETAM 500 mg Tablet3Preferred Brand17%17%None
LEVETIRACETAM 500 mg Tablet, Extended Release3Preferred Brand17%17%None
LEVETIRACETAM 500 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVETIRACETAM 500 mg Tablet, For Suspension4Non-Preferred Drug39%N/A
  • QL 18 per 30 days
LEVETIRACETAM 750 mg Tablet, Extended Release3Preferred Brand17%17%None
LEVETIRACETAM 750 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVOBUNOLOL HYDROCHLORIDE 5 mg/mL Solution/ Drops2Generic$8.00$24.00None
LEVOCARNITINE 1 g/10mL Solution3Preferred Brand17%17%None
LEVOCARNITINE 330 mg Tablet4Non-Preferred Drug39%N/ANone
LEVOCETIRIZINE DIHYDROCHLORIDE 5 mg Tablet3Preferred Brand17%17%
  • QL 3 per 30 days
LEVOFLOXACIN 25 mg/mL Solution4Non-Preferred Drug39%N/ANone
LEVOFLOXACIN 250 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVOFLOXACIN 5 mg/mL Injection, Solution4Non-Preferred Drug39%N/ANone
LEVOFLOXACIN 5 mg/mL Injection, Solution4Non-Preferred Drug39%N/ANone
LEVOFLOXACIN 500 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVOFLOXACIN 750 mg Tablet, Film Coated3Preferred Brand17%17%None
LEVONEST KitLevonorgestrel And Ethinyl Estradiol3Preferred Brand17%17%None
LEVONORGESTREL AND ETHINYL ESTRADIOL 90/20 ug Tablet3Preferred Brand17%17%None
LEVONORGESTREL AND ETHINYL ESTRADIOL AND ETHINYL ESTRADIOL KitLevonorgestrel And Ethinyl Estradiol3Preferred Brand17%17%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand17%17%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand17%17%None
LEVONORGESTREL AND ETHINYL ESTRADIOL Kit3Preferred Brand17%17%None
LEVOTHYROXINE SODIUM .2 mg Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM .3 mg Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 100 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 112 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 125 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 137 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 150 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 175 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 25 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 50 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 75 ug Tablet1Preferred Generic$2.00$6.00None
LEVOTHYROXINE SODIUM 88 ug Tablet1Preferred Generic$2.00$6.00None
LEVOXYL 100 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 112 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 125 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 137 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 150 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 175 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 200 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 25 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 50 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 75 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LEVOXYL 88 ug TabletLevothyroxine Sodium3Preferred Brand17%17%None
LIDOCAINE 50 mg/g Ointment4Non-Preferred Drug39%N/A
  • QL 152 per 30 days
LIDOCAINE 700 mg Patch4Non-Preferred Drug39%N/A
  • PA
  • QL 9 per 30 days
LIDOCAINE AND PRILOCAINE 25/25 mg/g Cream3Preferred Brand17%17%None
LIDOCAINE HYDROCHLORIDE 40 mg/mL Solution4Non-Preferred Drug39%N/ANone
LIDOCAINE VISCOUS 20 mg/mL SolutionLidocaine Hydrochloride2Generic$8.00$24.00None
LILETTA 52 mg Intrauterine DeviceLevonorgestrel3Preferred Brand17%17%None
LINEZOLID 100 mg/5mL Granule, For Suspension5Specialty Tier25%N/A
  • QL 18 per 30 days
LINEZOLID 600 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 6 per 30 days
LINEZOLID 600 mg/300mL Injection, Solution4Non-Preferred Drug39%N/ANone
LINZESS 145 ug Capsule, Gelatin CoatedLinaclotide3Preferred Brand17%17%
  • QL 3 per 30 days
LINZESS 290 ug Capsule, Gelatin CoatedLinaclotide3Preferred Brand17%17%
  • QL 3 per 30 days
LINZESS 72 ug Capsule, Gelatin CoatedLinaclotide3Preferred Brand17%17%
  • QL 3 per 30 days
LIOMNY 25 ug TabletLiothyronine Sodium3Preferred Brand17%17%None
LIOMNY 5 ug TabletLiothyronine Sodium3Preferred Brand17%17%None
LIOMNY 50 ug TabletLiothyronine Sodium3Preferred Brand17%17%None
LIOTHYRONINE SODIUM 25 ug Tablet3Preferred Brand17%17%None
LIOTHYRONINE SODIUM 5 ug Tablet3Preferred Brand17%17%None
LIOTHYRONINE SODIUM 50 ug Tablet3Preferred Brand17%17%None
LISINOPRIL 10 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL 2.5 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL 20 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL 30 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL 40 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL 5 mg Tablet1Preferred Generic$2.00$6.00
  • QL 6 per 30 days
LISINOPRIL AND HYDROCHLOROTHIAZIDE 12.5/10 mg Tablet2Generic$8.00$24.00
  • QL 3 per 30 days
LISINOPRIL AND HYDROCHLOROTHIAZIDE 12.5/20 mg Tablet2Generic$8.00$24.00
  • QL 12 per 30 days
LISINOPRIL AND HYDROCHLOROTHIAZIDE 25/20 mg Tablet2Generic$8.00$24.00
  • QL 6 per 30 days
LITHIUM 8 meq/5mL Solution3Preferred Brand17%17%None
LITHIUM CARBONATE 150 mg Capsule2Generic$8.00$24.00None
LITHIUM CARBONATE 300 mg Capsule2Generic$8.00$24.00None
LITHIUM CARBONATE 300 mg Tablet2Generic$8.00$24.00None
LITHIUM CARBONATE 300 mg Tablet, Film Coated, Extended Release2Generic$8.00$24.00None
LITHIUM CARBONATE 600 mg Capsule, Gelatin Coated2Generic$8.00$24.00None
LITHIUM CARBONATE ER 450 mg TabletLithium Carbonate2Generic$8.00$24.00None
LIVTENCITY 200 mg Tablet, CoatedMaribavir5Specialty Tier25%N/A
  • PA
  • QL 36 per 30 days
LOKELMA 10 g/10g Powder, For SuspensionSodium Zirconium Cyclosilicate4Non-Preferred Drug39%N/A
  • QL 9 per 30 days
LOKELMA 5 g/5g Powder, For SuspensionSodium Zirconium Cyclosilicate4Non-Preferred Drug39%N/A
  • QL 9 per 30 days
LOMUSTINE 10 mg Capsule4Non-Preferred Drug39%N/ANone
LOMUSTINE 100 mg Capsule5Specialty Tier25%N/ANone
LOMUSTINE 40 mg Capsule4Non-Preferred Drug39%N/ANone
LONSURF 15/6.14 mg Tablet, Film CoatedTrifluridine And Tipiracil5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LONSURF 20/8.19 mg Tablet, Film CoatedTrifluridine And Tipiracil5Specialty Tier25%N/A
  • PA
  • QL 24 per 30 days
LOPERAMIDE HYDROCHLORIDE 2 mg Capsule3Preferred Brand17%17%None
LOPINAVIR AND RITONAVIR 100/25 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 24 per 30 days
LOPINAVIR AND RITONAVIR 200/50 mg Tablet, Film Coated4Non-Preferred Drug39%N/A
  • QL 12 per 30 days
LORAZEPAM .5 mg Tablet2Generic$8.00$24.00
  • QL 12 per 30 days
LORAZEPAM 1 mg Tablet2Generic$8.00$24.00
  • QL 12 per 30 days
LORAZEPAM 2 mg Tablet2Generic$8.00$24.00
  • QL 15 per 30 days
LORBRENA 100 mg Tablet, Film CoatedLorlatinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LORBRENA 25 mg Tablet, Film CoatedLorlatinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LORYNA KitDrospirenone And Ethinyl Estradiol Tablets3Preferred Brand17%17%None
LOSARTAN POTASSIUM 100 mg Tablet, Film Coated1Preferred Generic$2.00$6.00None
LOSARTAN POTASSIUM 25 mg Tablet, Film Coated1Preferred Generic$2.00$6.00None
LOSARTAN POTASSIUM 50 mg Tablet, Film Coated1Preferred Generic$2.00$6.00None
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 12.5/100 mg Tablet2Generic$8.00$24.00None
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 12.5/50 mg Tablet2Generic$8.00$24.00None
LOSARTAN POTASSIUM AND HYDROCHLOROTHIAZIDE 25/100 mg Tablet2Generic$8.00$24.00None
LOVASTATIN 10 mg Tablet3Preferred Brand17%17%None
LOVASTATIN 20 mg Tablet3Preferred Brand17%17%None
LOVASTATIN 40 mg Tablet3Preferred Brand17%17%None
LOW-OGESTREL KitNorgestrel And Ethinyl Estradiol3Preferred Brand17%17%None
LOXAPINE 10 mg Capsule3Preferred Brand17%17%None
LOXAPINE 25 mg Capsule3Preferred Brand17%17%None
LOXAPINE 5 mg Capsule3Preferred Brand17%17%None
LOXAPINE 50 mg Capsule3Preferred Brand17%17%None
LUBIPROSTONE 24 ug Capsule, Gelatin Coated3Preferred Brand17%17%
  • QL 6 per 30 days
LUBIPROSTONE 8 ug Capsule, Gelatin Coated3Preferred Brand17%17%
  • QL 6 per 30 days
LUIZZA 1.5/30 30/1.5 ug/mg TabletNorethindrone Acetate And Ethinyl Estradiol3Preferred Brand17%17%None
LUIZZA 1/20 .02/1 mg TabletNorethindrone Acetate And Ethinyl Estradiol3Preferred Brand17%17%None
LUMAKRAS 120 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 24 per 30 days
LUMAKRAS 240 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LUMAKRAS 320 mg Tablet, CoatedSotorasib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
LUMRYZ 4.5 g For Suspension, Extended ReleaseSodium Oxybate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LUMRYZ 6 g For Suspension, Extended ReleaseSodium Oxybate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LUMRYZ 7.5 g For Suspension, Extended ReleaseSodium Oxybate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LUMRYZ 9 g For Suspension, Extended ReleaseSodium Oxybate5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
LUMRYZ KitSodium Oxybate5Specialty Tier25%N/A
  • PA
  • QL 56 per 365 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 28 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 28 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 84 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 84 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 168 days
LUPRON DEPOT KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 112 days
LUPRON DEPOT-PED KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 28 days
LUPRON DEPOT-PED KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 168 days
LUPRON DEPOT-PED KitLeuprolide Acetate5Specialty Tier25%N/A
  • PA
  • QL 1 per 84 days
LURASIDONE HYDROCHLORIDE 120 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 20 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 40 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 60 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
LURASIDONE HYDROCHLORIDE 80 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 6 per 30 days
LYLEQ .35 mg TabletNorethindrone3Preferred Brand17%17%None
LYNPARZA 100 mg Tablet, Film CoatedOlaparib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LYNPARZA 150 mg Tablet, Film CoatedOlaparib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
LYSODREN 500 mg TabletMitotane5Specialty Tier25%N/ANone
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 84 per 28 days
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
LYTGOBI 4 mg TabletFutibatinib5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 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.