MedicarePartD.guide

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2026 Wellcare Classic (PDP) formulary (drug list)

Contract S4802, plan 075 · New Hampshire · 2,922 drugs on file · formulary ID 00026191. Each drug links to its cost in every CMS PDP Region 01 plan.

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90 drugs starting with O.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug27%27%
  • PA
OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate5Specialty Tier25%N/A
  • PA
OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate5Specialty Tier25%N/A
  • PA
OCTREOTIDE ACETATE 200 ug/mL Injection, Solution4Non-Preferred Drug27%27%
  • PA
OCTREOTIDE ACETATE 50 ug/mL Injection, Solution4Non-Preferred Drug27%27%
  • PA
ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide5Specialty Tier25%N/ANone
ODOMZO 200 mg CapsuleSonidegib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OFEV 100 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OFEV 150 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OFLOXACIN 3 mg/mL Solution2Generic$10.00$30.00None
OFLOXACIN 3 mg/mL SolutionOfloxacin Otic4Non-Preferred Drug27%27%None
OGSIVEO 100 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
OGSIVEO 150 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 16 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 2 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 24 per 28 days
OJEMDA KitTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 96 per 28 days
OJJAARA 100 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OJJAARA 150 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OJJAARA 200 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OLANZAPINE 10 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 6 per 30 days
OLANZAPINE 10 mg Tablet, Orally Disintegrating4Non-Preferred Drug27%27%
  • QL 6 per 30 days
OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug27%27%
  • QL 3 per 1 days
OLANZAPINE 15 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 3 per 30 days
OLANZAPINE 15 mg Tablet, Orally Disintegrating4Non-Preferred Drug27%27%
  • QL 3 per 30 days
OLANZAPINE 2.5 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 6 per 30 days
OLANZAPINE 20 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 3 per 30 days
OLANZAPINE 20 mg Tablet, Orally Disintegrating4Non-Preferred Drug27%27%
  • QL 3 per 30 days
OLANZAPINE 5 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 6 per 30 days
OLANZAPINE 5 mg Tablet, Orally Disintegrating4Non-Preferred Drug27%27%
  • QL 3 per 30 days
OLANZAPINE 7.5 mg Tablet, Film Coated3Preferred Brand25%25%
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated2Generic$10.00$30.00
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated2Generic$10.00$30.00
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated2Generic$10.00$30.00
  • QL 6 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet3Preferred Brand25%25%
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet3Preferred Brand25%25%
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet3Preferred Brand25%25%
  • QL 3 per 30 days
OMEPRAZOLE 10 mg Capsule, Delayed Release2Generic$10.00$30.00
  • QL 6 per 30 days
OMEPRAZOLE 20 mg Capsule, Delayed Release2Generic$10.00$30.00
  • QL 6 per 30 days
OMEPRAZOLE 40 mg Capsule, Delayed Release2Generic$10.00$30.00
  • QL 6 per 30 days
OMNITROPE 10 mg/1.5mL Injection, SolutionSomatropin5Specialty Tier25%N/A
  • PA
OMNITROPE 5 mg/1.5mL Injection, SolutionSomatropin5Specialty Tier25%N/A
  • PA
OMNITROPE KitSomatropin5Specialty Tier25%N/A
  • PA
ONDANSETRON 4 mg Tablet, Orally Disintegrating3Preferred Brand25%25%None
ONDANSETRON 8 mg Tablet, Orally Disintegrating3Preferred Brand25%25%None
ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated3Preferred Brand25%25%None
ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated3Preferred Brand25%25%None
ONUREG 200 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
ONUREG 300 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
OPIPZA 10 mg Film, SolubleAripiprazole4Non-Preferred Drug27%27%
  • QL 9 per 30 days
OPIPZA 2 mg Film, SolubleAripiprazole4Non-Preferred Drug27%27%
  • QL 3 per 30 days
OPIPZA 5 mg Film, SolubleAripiprazole4Non-Preferred Drug27%27%
  • QL 18 per 30 days
ORGOVYX 120 mg Tablet, Film CoatedRelugolix5Specialty Tier25%N/A
  • PA
  • QL 3 per 28 days
ORQUIDEA .35 mg TabletNorethindrone3Preferred Brand25%25%None
ORSERDU 345 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
ORSERDU 86 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
OSELTAMIVIR PHOSPHATE 30 mg Capsule4Non-Preferred Drug27%27%
  • QL 168 per 365 days
OSELTAMIVIR PHOSPHATE 45 mg Capsule4Non-Preferred Drug27%27%
  • QL 84 per 365 days
OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension4Non-Preferred Drug27%27%
  • QL 108 per 365 days
OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir4Non-Preferred Drug27%27%
  • QL 84 per 365 days
OSENVELT 120 mg/1.7mL InjectionDenosumab-Bmwo5Specialty Tier25%N/A
  • PA
OTEZLA 20 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA 30 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA 75 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 55 per 180 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 55 per 180 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 41 per 180 days
OXCARBAZEPINE 150 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
OXCARBAZEPINE 300 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
OXCARBAZEPINE 300 mg/5mL Suspension4Non-Preferred Drug27%27%None
OXCARBAZEPINE 600 mg Tablet, Film Coated4Non-Preferred Drug27%27%None
OXERVATE 20 ug/mL Solution/ DropsCenegermin-Bkbj5Specialty Tier25%N/A
  • PA
OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release3Preferred Brand25%25%
  • QL 6 per 30 days
OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release3Preferred Brand25%25%
  • QL 3 per 30 days
OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release3Preferred Brand25%25%
  • QL 6 per 30 days
OXYBUTYNIN CHLORIDE 5 mg Tablet3Preferred Brand25%25%
  • QL 12 per 30 days
OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup3Preferred Brand25%25%
  • QL 6 per 30 days
OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet4Non-Preferred Drug27%27%
  • QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen4Non-Preferred Drug27%27%
  • QL 36 per 30 days
OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen4Non-Preferred Drug27%27%
  • QL 24 per 30 days
OXYCODONE HYDROCHLORIDE 10 mg Tablet4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 15 mg Tablet4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 20 mg Tablet4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 30 mg Tablet4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 5 mg Tablet4Non-Preferred Drug27%27%
  • QL 18 per 30 days
OXYCODONE HYDROCHLORIDE 5 mg/5mL Solution4Non-Preferred Drug27%27%
  • QL 9 per 30 days
OZEMPIC .68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 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.