2026 HealthSpring Assurance Rx (PDP) formulary (drug list)
Contract S5617, plan 068 · Ohio · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 14 plan.
134 drugs starting with F.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| FALMINA KitLevonorgestrel And Ethinyl Estradiol | 4Non-Preferred Drug | 33% | 33% | None |
| FAMCICLOVIR 125 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% |
|
| FAMCICLOVIR 250 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% |
|
| FAMCICLOVIR 500 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% |
|
| FAMOTIDINE 20 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% | None |
| FAMOTIDINE 40 mg Tablet, Film Coated | 3Preferred Brand | 21% | 21% | None |
| FAMOTIDINE 40 mg/5mL Powder, For Suspension | 4Non-Preferred Drug | 33% | 33% | None |
| FANAPT 1 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 10 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 12 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 2 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 4 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 6 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT 8 mg TabletIloperidone | 5Specialty Tier | 25% | N/A |
|
| FANAPT KitIloperidone | 4Non-Preferred Drug | 33% | 33% |
|
| FARXIGA 10 mg Tablet, Film CoatedDapagliflozin | 3Preferred Brand | 21% | 21% |
|
| FARXIGA 5 mg Tablet, Film CoatedDapagliflozin | 3Preferred Brand | 21% | 21% |
|
| FASENRA 10 mg/.5mL Injection, SolutionBenralizumab | 5Specialty Tier | 25% | N/A |
|
| FASENRA 30 mg/mL Injection, SolutionBenralizumab | 5Specialty Tier | 25% | N/A |
|
| FASENRA 30 mg/mL Injection, SolutionBenralizumab | 5Specialty Tier | 25% | N/A |
|
| FEBUXOSTAT 40 mg Tablet, Coated | 4Non-Preferred Drug | 33% | 33% | None |
| FEBUXOSTAT 80 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% | None |
| FEIRZA 1.5/30 TM KitNorethindrone Acetate And Ethinyl Estradiol Tablets Usp, 1.5 Mg/30 Mcg And Ferrous Fumarate Tablets, 75 Mg | 4Non-Preferred Drug | 33% | 33% | None |
| FEIRZA 1/20 KitNorethindrone Acetate And Ethinyl Estradiol Tablets Usp, 1 Mg/0.02 Mg And Ferrous Fumarate Tablets, 75 Mg | 4Non-Preferred Drug | 33% | 33% | None |
| FELBAMATE 400 mg Tablet | 4Non-Preferred Drug | 33% | 33% | None |
| FELBAMATE 600 mg Tablet | 4Non-Preferred Drug | 33% | 33% | None |
| FELBAMATE 600 mg/5mL Suspension | 4Non-Preferred Drug | 33% | 33% | None |
| FELODIPINE 10 mg Tablet, Extended Release | 2Generic | $2.00 | $2.00 | None |
| FELODIPINE 2.5 mg Tablet, Extended Release | 2Generic | $2.00 | $2.00 | None |
| FELODIPINE 5 mg Tablet, Extended Release | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 134 mg Capsule | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 145 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 160 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 200 mg Capsule | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 48 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 54 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRATE 67 mg Capsule | 2Generic | $2.00 | $2.00 | None |
| FENOFIBRIC ACID 135 mg Capsule, Delayed Release | 2Generic | $2.00 | $2.00 | None |
| FENTANYL 100 ug/h Patch | 4Non-Preferred Drug | 33% | 33% |
|
| FENTANYL 12 ug/h Patch | 4Non-Preferred Drug | 33% | 33% |
|
| FENTANYL 25 ug/h Patch | 4Non-Preferred Drug | 33% | 33% |
|
| FENTANYL 50 ug/h Patch | 4Non-Preferred Drug | 33% | 33% |
|
| FENTANYL 75 ug/h Patch | 4Non-Preferred Drug | 33% | 33% |
|
| FETZIMA 120 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 33% | 33% |
|
| FETZIMA 20 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 33% | 33% |
|
| FETZIMA 40 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 33% | 33% |
|
| FETZIMA 80 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 33% | 33% |
|
| FETZIMA KitLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 33% | 33% |
|
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 21% | 21% | None |
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 21% | 21% | None |
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 21% | 21% | None |
| FIDAXOMICIN 200 mg Tablet, Film Coated | 5Specialty Tier | 25% | N/A |
|
| FINASTERIDE 5 mg Tablet, Film Coated | 2Generic | $2.00 | $2.00 |
|
| FINTEPLA 2.2 mg/mL SolutionFenfluramine | 5Specialty Tier | 25% | N/A |
|
| FIRMAGON KitDegarelix | 4Non-Preferred Drug | 33% | 33% |
|
| FIRMAGON KitDegarelix | 5Specialty Tier | 25% | N/A |
|
| FLECAINIDE ACETATE 100 mg TabletFlecainide Acetate Tablet | 4Non-Preferred Drug | 33% | 33% | None |
| FLECAINIDE ACETATE 150 mg TabletFlecainide Acetate Tablet | 4Non-Preferred Drug | 33% | 33% | None |
| FLECAINIDE ACETATE 50 mg TabletFlecainide Acetate Tablet | 4Non-Preferred Drug | 33% | 33% | None |
| FLUCONAZOLE 10 mg/mL Powder, For Suspension | 3Preferred Brand | 21% | 21% | None |
| FLUCONAZOLE 100 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLUCONAZOLE 150 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLUCONAZOLE 2 mg/mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% |
|
| FLUCONAZOLE 2 mg/mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% |
|
| FLUCONAZOLE 200 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLUCONAZOLE 40 mg/mL Powder, For Suspension | 3Preferred Brand | 21% | 21% | None |
| FLUCONAZOLE 50 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLUCYTOSINE 250 mg Capsule | 5Specialty Tier | 25% | N/A | None |
| FLUCYTOSINE 500 mg Capsule | 5Specialty Tier | 25% | N/A | None |
| FLUDROCORTISONE ACETATE .1 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLUNISOLIDE .25 mg/mL Solution | 3Preferred Brand | 21% | 21% |
|
| FLUOCINOLONE ACETONIDE .1 mg/g Cream | 3Preferred Brand | 21% | 21% | None |
| FLUOCINOLONE ACETONIDE .1 mg/mL Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FLUOCINOLONE ACETONIDE .11 mg/118.28mL Oil | 4Non-Preferred Drug | 33% | 33% | None |
| FLUOCINOLONE ACETONIDE .25 mg/g Cream | 4Non-Preferred Drug | 33% | 33% | None |
| FLUOCINOLONE ACETONIDE .25 mg/g Ointment | 4Non-Preferred Drug | 33% | 33% | None |
| FLUOCINOLONE ACETONIDE OIL .11 mg/mL OilFluocinolone Acetonide | 4Non-Preferred Drug | 33% | 33% | None |
| FLUOCINONIDE .5 mg/g Cream | 3Preferred Brand | 21% | 21% |
|
| FLUOCINONIDE .5 mg/g Gel | 4Non-Preferred Drug | 33% | 33% |
|
| FLUOCINONIDE .5 mg/g Ointment | 4Non-Preferred Drug | 33% | 33% |
|
| FLUOCINONIDE .5 mg/mL SolutionFluocinonide Topical Solution Usp, 0.05% | 4Non-Preferred Drug | 33% | 33% |
|
| FLUOROMETHOLONE OPHTHALMIC SUSPENSION 1 mg/mL Suspension/ DropsFluorometholone | 3Preferred Brand | 21% | 21% | None |
| FLUOROURACIL 20 mg/mL Solution | 3Preferred Brand | 21% | 21% | None |
| FLUOROURACIL 50 mg/g Cream | 3Preferred Brand | 21% | 21% | None |
| FLUOROURACIL 50 mg/mL Solution | 3Preferred Brand | 21% | 21% | None |
| FLUOXETINE 10 mg Capsule | 2Generic | $2.00 | $2.00 |
|
| FLUOXETINE 20 mg Capsule | 2Generic | $2.00 | $2.00 |
|
| FLUOXETINE 20 mg/5mL Solution | 2Generic | $2.00 | $2.00 | None |
| FLUOXETINE 40 mg Capsule | 2Generic | $2.00 | $2.00 |
|
| FLUPHENAZINE DECANOATE 25 mg/mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FLUPHENAZINE HYDROCHLORIDE .5 mg/mL Elixir | 4Non-Preferred Drug | 33% | 33% | None |
| FLUPHENAZINE HYDROCHLORIDE 1 mg Tablet, Film Coated | 3Preferred Brand | 21% | 21% | None |
| FLUPHENAZINE HYDROCHLORIDE 10 mg Tablet, Film Coated | 3Preferred Brand | 21% | 21% | None |
| FLUPHENAZINE HYDROCHLORIDE 2.5 mg Tablet, Film Coated | 3Preferred Brand | 21% | 21% | None |
| FLUPHENAZINE HYDROCHLORIDE 2.5 mg/mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FLUPHENAZINE HYDROCHLORIDE 5 mg Tablet, Film Coated | 3Preferred Brand | 21% | 21% | None |
| FLUPHENAZINE HYDROCHLORIDE 5 mg/mL Solution, Concentrate | 4Non-Preferred Drug | 33% | 33% | None |
| FLURBIPROFEN 100 mg Tablet | 2Generic | $2.00 | $2.00 | None |
| FLURBIPROFEN SODIUM .3 mg/mL Solution/ Drops | 3Preferred Brand | 21% | 21% | None |
| FLUTICASONE PROPIONATE .05 mg/g Ointment | 3Preferred Brand | 21% | 21% | None |
| FLUTICASONE PROPIONATE .5 mg/g Cream | 4Non-Preferred Drug | 33% | 33% | None |
| FLUTICASONE PROPIONATE 50 ug Spray, Metered | 2Generic | $2.00 | $2.00 |
|
| FLUVASTATIN SODIUM 20 mg CapsuleFluvastatin | 1Preferred Generic | $0.00 | $0.00 |
|
| FLUVASTATIN SODIUM 40 mg CapsuleFluvastatin | 1Preferred Generic | $0.00 | $0.00 |
|
| FLUVASTATIN SODIUM 80 mg Tablet, Film Coated, Extended Release | 1Preferred Generic | $0.00 | $0.00 |
|
| FLUVOXAMINE MALEATE 100 mg Tablet | 3Preferred Brand | 21% | 21% |
|
| FLUVOXAMINE MALEATE 25 mg Tablet | 2Generic | $2.00 | $2.00 |
|
| FLUVOXAMINE MALEATE 50 mg Tablet | 2Generic | $2.00 | $2.00 |
|
| FONDAPARINUX SODIUM 10 mg/.8mL Injection, Solution | 5Specialty Tier | 25% | N/A | None |
| FONDAPARINUX SODIUM 2.5 mg/.5mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FONDAPARINUX SODIUM 5 mg/.4mL Injection, Solution | 5Specialty Tier | 25% | N/A | None |
| FONDAPARINUX SODIUM 7.5 mg/.6mL Injection, Solution | 5Specialty Tier | 25% | N/A | None |
| FOSAMPRENAVIR CALCIUM 700 mg Tablet, Film Coated | 4Non-Preferred Drug | 33% | 33% |
|
| FOSFOMYCIN TROMETHAMINE 3 g PowderGranules For Oral Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FOSINOPRIL SODIUM 10 mg TabletFosinopirl Sodium | 1Preferred Generic | $0.00 | $0.00 | None |
| FOSINOPRIL SODIUM 20 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FOSINOPRIL SODIUM 40 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FOSINOPRIL SODIUM AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FOSINOPRIL SODIUM AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FRUZAQLA 1 mg CapsuleFruquintinib | 5Specialty Tier | 25% | N/A |
|
| FRUZAQLA 5 mg CapsuleFruquintinib | 5Specialty Tier | 25% | N/A |
|
| FUROSEMIDE 10 mg/mL Injection, Solution | 4Non-Preferred Drug | 33% | 33% | None |
| FUROSEMIDE 10 mg/mL Solution | 2Generic | $2.00 | $2.00 | None |
| FUROSEMIDE 20 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FUROSEMIDE 40 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FUROSEMIDE 40 mg/5mL Solution | 2Generic | $2.00 | $2.00 | None |
| FUROSEMIDE 80 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| FYCOMPA .5 mg/mL SuspensionPerampanel | 5Specialty Tier | 25% | N/A |
|
| FYCOMPA 10 mg TabletPerampanel | 5Specialty Tier | 25% | N/A |
|
| FYCOMPA 12 mg TabletPerampanel | 5Specialty Tier | 25% | N/A |
|
| FYCOMPA 2 mg TabletPerampanel | 4Non-Preferred Drug | 33% | 33% |
|
| FYCOMPA 4 mg TabletPerampanel | 5Specialty Tier | 25% | N/A |
|
| FYCOMPA 6 mg TabletPerampanel | 5Specialty Tier | 25% | N/A |
|
| FYCOMPA 8 mg TabletPerampanel | 5Specialty Tier | 25% | N/A |
|
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.