2026 Wellcare Value Script (PDP) formulary (drug list)
Contract S4802, plan 159 · New Mexico · 3,194 drugs on file · formulary ID 00026195. Each drug links to its cost in every CMS PDP Region 26 plan.
123 drugs starting with B.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| BACITRACIN ZINC AND POLYMYXIN B SULFATE 500/10000 [USP'U]/g Ointment | 2Generic | $3.00 | $9.00 | None |
| BACLOFEN 10 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BACLOFEN 20 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BACLOFEN 5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BALSALAZIDE DISODIUM 750 mg Capsule | 4Non-Preferred Drug | 40% | 40% | None |
| BALVERSA 3 mg Tablet, Film CoatedErdafitinib | 5Specialty Tier | 25% | N/A |
|
| BALVERSA 4 mg Tablet, Film CoatedErdafitinib | 5Specialty Tier | 25% | N/A |
|
| BALVERSA 5 mg Tablet, Film CoatedErdafitinib | 5Specialty Tier | 25% | N/A |
|
| BARACLUDE .05 mg/mL SolutionEntecavir | 5Specialty Tier | 25% | N/A | None |
| BCG VACCINE 50 mg Injection, Powder, Lyophilized, For SolutionBacillus Calmette-Guerin Substrain Tice Live Antigen | 3Preferred Brand | 25% | 25% | None |
| BELSOMRA 10 mg Tablet, Film CoatedSuvorexant | 3Preferred Brand | 25% | 25% |
|
| BELSOMRA 15 mg Tablet, Film CoatedSuvorexant | 3Preferred Brand | 25% | 25% |
|
| BELSOMRA 20 mg Tablet, Film CoatedSuvorexant | 3Preferred Brand | 25% | 25% |
|
| BELSOMRA 5 mg Tablet, Film CoatedSuvorexant | 3Preferred Brand | 25% | 25% |
|
| BENAZEPRIL HYDROCHLORIDE 10 mg Tablet, Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE 20 mg Tablet, Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE 40 mg Tablet, Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE 5 mg Tablet, Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/25 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 5/6.25 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 | None |
| BENLYSTA 200 mg/mL SolutionBelimumab | 5Specialty Tier | 25% | N/A |
|
| BENLYSTA 200 mg/mL SolutionBelimumab | 5Specialty Tier | 25% | N/A |
|
| BENZTROPINE MESYLATE .5 mg Tablet | 4Non-Preferred Drug | 40% | 40% |
|
| BENZTROPINE MESYLATE 1 mg Tablet | 4Non-Preferred Drug | 40% | 40% |
|
| BENZTROPINE MESYLATE 2 mg Tablet | 4Non-Preferred Drug | 40% | 40% |
|
| BESREMI 500 ug/mL InjectionRopeginterferon Alfa-2B | 5Specialty Tier | 25% | N/A |
|
| BETAINE 1 g/g Powder, For Solution | 5Specialty Tier | 25% | N/A | None |
| BETAMETHASONE DIPROPIONATE .5 mg/g Cream | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE DIPROPIONATE .5 mg/g Cream, Augmented | 2Generic | $3.00 | $9.00 |
|
| BETAMETHASONE DIPROPIONATE .5 mg/g Gel | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE DIPROPIONATE .5 mg/g Lotion | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE DIPROPIONATE .5 mg/g Ointment | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE DIPROPIONATE .5 mg/g Ointment, Augmented | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE DIPROPIONATE .5 mg/mL Lotion, Augmented | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE VALERATE 1 mg/mL Lotion | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE VALERATE 1.2 mg/g Cream | 4Non-Preferred Drug | 40% | 40% |
|
| BETAMETHASONE VALERATE 1.2 mg/g Ointment | 4Non-Preferred Drug | 40% | 40% |
|
| BETASERON KitInterferon Beta-1B | 5Specialty Tier | 25% | N/A |
|
| BETAXOLOL HYDROCHLORIDE 5.6 mg/mL Solution/ Drops | 4Non-Preferred Drug | 40% | 40% | None |
| BETHANECHOL CHLORIDE 10 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BETHANECHOL CHLORIDE 25 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BETHANECHOL CHLORIDE 5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BETHANECHOL CHLORIDE 50 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BEVESPI AEROSPHERE 9/4.8 ug Aerosol, MeteredGlycopyrrolate And Formoterol Fumarate | 3Preferred Brand | 25% | 25% |
|
| BEXAROTENE 10 mg/g Gel | 5Specialty Tier | 25% | N/A |
|
| BEXAROTENE 75 mg Capsule, Liquid Filled | 5Specialty Tier | 25% | N/A |
|
| BEXSERO 50/50/50/25 ug/.5mL Injection, SuspensionNeisseria Meningitidis Serogroup B Nhba Fusion Protein Antigen, Neisseria Meningitidis Serogroup B Fhbp Fusion Protein Antigen And Neisseria Meningitidis Serogroup B Nada Protein Antigen | 3Preferred Brand | 25% | 25% | None |
| BICALUTAMIDE 50 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BICILLIN L-A 1200000 [iU]/2mL Injection, SuspensionPenicillin G Benzathine | 4Non-Preferred Drug | 40% | 40% | None |
| BICILLIN L-A 2400000 [iU]/4mL Injection, SuspensionPenicillin G Benzathine | 4Non-Preferred Drug | 40% | 40% | None |
| BICILLIN L-A 600000 [iU]/mL Injection, SuspensionPenicillin G Benzathine | 4Non-Preferred Drug | 40% | 40% | None |
| BIKTARVY 30/120/15 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate | 5Specialty Tier | 25% | N/A | None |
| BIKTARVY 50/200/25 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate | 5Specialty Tier | 25% | N/A | None |
| BISOPROLOL FUMARATE 10 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BISOPROLOL FUMARATE 5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/10 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/2.5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BLISOVI FE 1.5/30 KitNorethindrone Acetate And Ethinyl Estradiol | 2Generic | $3.00 | $9.00 | None |
| BOMYNTRA 70 mg/mL InjectionDenosumab | 5Specialty Tier | 25% | N/A |
|
| BOMYNTRA 70 mg/mL InjectionDenosumab | 5Specialty Tier | 25% | N/A |
|
| BONSITY 250 ug/mL Injection, SolutionTeriparatide | 5Specialty Tier | 25% | N/A |
|
| BOOSTRIX 5/2.5/8/8/2.5 [iU]/.5mL/ug/.5mL SuspensionTetanus Toxoid, Reduced Diphtheria Toxoid And Acellular Pertussis Vaccine, Adsorbed | 3Preferred Brand | 25% | 25% | None |
| BOSULIF 100 mg CapsuleBosutinib | 5Specialty Tier | 25% | N/A |
|
| BOSULIF 100 mg Tablet, Film CoatedBosutinib | 5Specialty Tier | 25% | N/A |
|
| BOSULIF 400 mg Tablet, Film CoatedBosutinib | 5Specialty Tier | 25% | N/A |
|
| BOSULIF 50 mg CapsuleBosutinib | 5Specialty Tier | 25% | N/A |
|
| BOSULIF 500 mg Tablet, Film CoatedBosutinib | 5Specialty Tier | 25% | N/A |
|
| BRAFTOVI 75 mg CapsuleEncorafenib | 5Specialty Tier | 25% | N/A |
|
| BREO ELLIPTA 100/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate | 3Preferred Brand | 25% | 25% |
|
| BREO ELLIPTA 200/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate | 3Preferred Brand | 25% | 25% |
|
| BREO ELLIPTA 50/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate | 3Preferred Brand | 25% | 25% |
|
| BREYNA 160/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate | 3Preferred Brand | 25% | 25% |
|
| BREYNA 80/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate | 3Preferred Brand | 25% | 25% |
|
| BREZTRI 160/9/4.8 ug Aerosol, MeteredBudesonide, Glycopyrrolate, And Formoterol Fumarate | 3Preferred Brand | 25% | 25% |
|
| BRIMONIDINE TARTRATE 2 mg/mL Solution/ Drops | 1Preferred Generic | $0.00 | $0.00 | None |
| BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION, 0.15% 1.5 mg/mL Solution/ Drops | 4Non-Preferred Drug | 40% | 40% | None |
| BRINSUPRI 10 mg TabletBrensocatib | 5Specialty Tier | 25% | N/A |
|
| BRINSUPRI 25 mg TabletBrensocatib | 5Specialty Tier | 25% | N/A |
|
| BRINZOLAMIDE 10 mg/mL Suspension/ Drops | 4Non-Preferred Drug | 40% | 40% | None |
| BRIVIACT 10 mg Tablet, Film CoatedBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BRIVIACT 10 mg/mL SolutionBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BRIVIACT 100 mg Tablet, Film CoatedBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BRIVIACT 25 mg Tablet, Film CoatedBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BRIVIACT 50 mg Tablet, Film CoatedBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BRIVIACT 75 mg Tablet, Film CoatedBrivaracetam | 5Specialty Tier | 25% | N/A |
|
| BROMFENAC .75 mg/mL Solution/ Drops | 4Non-Preferred Drug | 40% | 40% | None |
| BROMFENAC OPHTHALMIC SOLUTION 0.09% 1.035 mg/mL Solution/ Drops | 4Non-Preferred Drug | 40% | 40% | None |
| BROMOCRIPTINE MESYLATE 2.5 mg Tablet | 4Non-Preferred Drug | 40% | 40% | None |
| BROMOCRIPTINE MESYLATE 5 mg Capsule | 4Non-Preferred Drug | 40% | 40% | None |
| BRUKINSA 160 mg Tablet, Film CoatedZanubrutinib | 5Specialty Tier | 25% | N/A |
|
| BUDESONIDE .25 mg/2mL Suspension | 4Non-Preferred Drug | 40% | 40% |
|
| BUDESONIDE .5 mg/2mL Suspension | 4Non-Preferred Drug | 40% | 40% |
|
| BUDESONIDE 3 mg Capsule, Delayed Release | 4Non-Preferred Drug | 40% | 40% | None |
| BUDESONIDE 9 mg Tablet, Extended Release | 5Specialty Tier | 25% | N/A |
|
| BUMETANIDE .25 mg/mL Injection, Solution | 4Non-Preferred Drug | 40% | 40% | None |
| BUMETANIDE .5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUMETANIDE 1 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUMETANIDE 2 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUPRENORPHINE 2 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUPRENORPHINE 8 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUPRENORPHINE AND NALOXONE 2/.5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUPRENORPHINE AND NALOXONE 8/2 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 12/3 mg FilmBuprenorphine And Naloxone | 4Non-Preferred Drug | 40% | 40% | None |
| BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 2/.5 mg FilmBuprenorphine And Naloxone | 4Non-Preferred Drug | 40% | 40% | None |
| BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 4/1 mg FilmBuprenorphine And Naloxone | 4Non-Preferred Drug | 40% | 40% | None |
| BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 8/2 mg FilmBuprenorphine And Naloxone | 4Non-Preferred Drug | 40% | 40% | None |
| BUPROPION HYDROCHLORIDE 100 mg Tablet, Film Coated | 3Preferred Brand | 25% | 25% | None |
| BUPROPION HYDROCHLORIDE 75 mg Tablet, Film Coated | 3Preferred Brand | 25% | 25% | None |
| BUPROPION HYDROCHLORIDE SR 100 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUPROPION HYDROCHLORIDE SR 200 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUPROPION HYDROCHLORIDE XL 150 mg Tablet, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUPROPION HYDROCHLORIDE XL 300 mg Tablet, Extended ReleaseBupropion Hydrochloride | 3Preferred Brand | 25% | 25% |
|
| BUSPIRONE HYDROCHLORIDE 10 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| BUSPIRONE HYDROCHLORIDE 15 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| BUSPIRONE HYDROCHLORIDE 30 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUSPIRONE HYDROCHLORIDE 5 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| BUSPIRONE HYDROCHLORIDE 7.5 mg Tablet | 2Generic | $3.00 | $9.00 | None |
| BUTORPHANOL TARTRATE 10 mg/mL Spray, Metered | 4Non-Preferred Drug | 40% | 40% |
|
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.