2026 HealthSpring Assurance Rx (PDP) formulary (drug list)
Contract S5617, plan 123 · Nebraska · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 25 plan.
18 drugs starting with Q.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| QINLOCK 50 mg TabletRipretinib | 5Specialty Tier | 25% | N/A |
|
| QUETIAPINE 100 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE 200 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE 25 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE 300 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE 400 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE 50 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUETIAPINE FUMARATE 150 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| QUINAPRIL 10 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| QUINAPRIL 20 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| QUINAPRIL 40 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| QUINAPRIL 5 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| QUINAPRIL AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| QUINAPRIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| QUINAPRIL AND HYDROCHLOROTHIAZIDE 20/25 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| QUINIDINE SULFATE 200 mg TabletQuinidine Sulfate Tablet | 2Generic | $2.00 | $2.00 | None |
| QUINIDINE SULFATE 300 mg TabletQuinidine Sulfate Tablet | 2Generic | $2.00 | $2.00 | None |
| QUININE SULFATE 324 mg Capsule | 4Non-Preferred Drug | 30% | 30% |
|
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.