MedicarePartD.guide

A non-government resource built from CMS public data

2026 Blue Rx PDP Plus (PDP) formulary (drug list)

Contract S5593, plan 002 · Pennsylvania · 3,788 drugs on file · formulary ID 00026017. Each drug links to its cost in every CMS PDP Region 06 plan.

Hide drugs on tiers

139 drugs starting with B.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
BACITRACIN ZINC AND POLYMYXIN B SULFATE 500/10000 [USP'U]/g Ointment2Generic25%25%None
BACLOFEN 10 mg Tablet1Preferred Generic25%25%None
BACLOFEN 20 mg Tablet2Generic25%25%None
BAFIERTAM 95 mg CapsuleMonomethyl Fumarate5Specialty Tier25%25%
  • PA
  • QL 124 per 31 days
BALSALAZIDE DISODIUM 750 mg Capsule2Generic25%25%None
BALVERSA 3 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%25%
  • PA
BALVERSA 4 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%25%
  • PA
BALVERSA 5 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%25%
  • PA
BALZIVA KitNorethindrone And Ethinyl Estradiol2Generic25%25%None
BCG VACCINE 50 mg Injection, Powder, Lyophilized, For SolutionBacillus Calmette-Guerin Substrain Tice Live Antigen3Preferred Brand25%25%None
BENAZEPRIL HYDROCHLORIDE 10 mg Tablet, Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE 20 mg Tablet, Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE 40 mg Tablet, Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE 5 mg Tablet, Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet, Film Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet, Film Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/25 mg Tablet, Film Coated1Preferred Generic25%25%None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 5/6.25 mg Tablet, Film Coated1Preferred Generic25%25%None
BENLYSTA 200 mg/mL SolutionBelimumab5Specialty Tier25%25%
  • PA
  • QL 4 per 28 days
BENLYSTA 200 mg/mL SolutionBelimumab5Specialty Tier25%25%
  • PA
  • QL 4 per 28 days
BENZTROPINE MESYLATE .5 mg Tablet2Generic25%25%
  • PA
BENZTROPINE MESYLATE 1 mg Tablet2Generic25%25%
  • PA
BENZTROPINE MESYLATE 2 mg Tablet2Generic25%25%
  • PA
BESIVANCE 6 mg/mL SuspensionBesifloxacin4Non-Preferred Drug25%25%None
BESREMI 500 ug/mL InjectionRopeginterferon Alfa-2B5Specialty Tier25%25%
  • PA
  • QL 2 per 28 days
BETAINE 1 g/g Powder, For Solution5Specialty Tier25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Cream1Preferred Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Cream, Augmented2Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Gel2Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Lotion1Preferred Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Ointment1Preferred Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/g Ointment, Augmented2Generic25%25%None
BETAMETHASONE DIPROPIONATE .5 mg/mL Lotion, Augmented2Generic25%25%None
BETAMETHASONE VALERATE 1 mg/mL Lotion2Generic25%25%None
BETAMETHASONE VALERATE 1.2 mg/g Aerosol, Foam4Non-Preferred Drug25%25%None
BETAMETHASONE VALERATE 1.2 mg/g Cream2Generic25%25%None
BETAMETHASONE VALERATE 1.2 mg/g Ointment2Generic25%25%None
BETASERON KitInterferon Beta-1B5Specialty Tier25%25%
  • PA
  • QL 14 per 28 days
BETAXOLOL HYDROCHLORIDE 10 mg Tablet, Coated1Preferred Generic25%25%None
BETAXOLOL HYDROCHLORIDE 20 mg Tablet, Coated1Preferred Generic25%25%None
BETAXOLOL HYDROCHLORIDE 5.6 mg/mL Solution/ Drops2Generic25%25%None
BETHANECHOL CHLORIDE 10 mg Tablet2Generic25%25%None
BETHANECHOL CHLORIDE 25 mg Tablet2Generic25%25%None
BETHANECHOL CHLORIDE 5 mg Tablet2Generic25%25%None
BETHANECHOL CHLORIDE 50 mg Tablet3Preferred Brand25%25%None
BEXAROTENE 10 mg/g Gel5Specialty Tier25%25%
  • PA
  • QL 6 per 28 days
BEXAROTENE 75 mg Capsule, Liquid Filled5Specialty Tier25%25%
  • PA
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 Antigen3Preferred Brand25%25%None
BICALUTAMIDE 50 mg Tablet2Generic25%25%None
BICILLIN C-R 900/300 900000/300000 [iU]/2mL Injection, SuspensionPenicillin G Benzathine And Penicillin G Procaine3Preferred Brand25%25%None
BICILLIN CR 600000/600000 [iU]/2mL Injection, SuspensionPenicillin G Benzathine And Penicillin G Procaine3Preferred Brand25%25%None
BICILLIN L-A 600000 [iU]/mL Injection, SuspensionPenicillin G Benzathine3Preferred Brand25%25%None
BIKTARVY 30/120/15 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate5Specialty Tier25%25%
  • QL 31 per 31 days
BIKTARVY 50/200/25 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate5Specialty Tier25%25%
  • QL 31 per 31 days
BIMATOPROST .3 mg/mL Solution/ Drops2Generic25%25%None
BISOPROLOL FUMARATE 10 mg Tablet1Preferred Generic25%25%None
BISOPROLOL FUMARATE 5 mg Tablet1Preferred Generic25%25%None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/10 mg Tablet1Preferred Generic25%25%None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/2.5 mg Tablet1Preferred Generic25%25%None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/5 mg Tablet1Preferred Generic25%25%None
BLISOVI FE 1.5/30 KitNorethindrone Acetate And Ethinyl Estradiol2Generic25%25%None
BLUJEPA 750 mg Tablet, Film CoatedGepotidacin4Non-Preferred Drug25%25%
  • QL 2 per 5 days
BOOSTRIX 5/2.5/8/8/2.5 [iU]/.5mL/ug/.5mL SuspensionTetanus Toxoid, Reduced Diphtheria Toxoid And Acellular Pertussis Vaccine, Adsorbed3Preferred Brand25%25%None
BOSENTAN 125 mg Tablet, Coated5Specialty Tier25%25%
  • PA
  • QL 62 per 31 days
BOSENTAN 62.5 mg Tablet, Coated5Specialty Tier25%25%
  • PA
  • QL 62 per 31 days
BOSULIF 100 mg CapsuleBosutinib5Specialty Tier25%25%
  • PA
  • QL 186 per 31 days
BOSULIF 100 mg Tablet, Film CoatedBosutinib5Specialty Tier25%25%
  • PA
  • QL 93 per 31 days
BOSULIF 400 mg Tablet, Film CoatedBosutinib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
BOSULIF 50 mg CapsuleBosutinib5Specialty Tier25%25%
  • PA
  • QL 341 per 31 days
BOSULIF 500 mg Tablet, Film CoatedBosutinib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
BRAFTOVI 75 mg CapsuleEncorafenib5Specialty Tier25%25%
  • PA
  • QL 186 per 31 days
BREO ELLIPTA 100/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand25%25%
  • QL 6 per 30 days
BREO ELLIPTA 200/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand25%25%
  • QL 6 per 30 days
BREO ELLIPTA 50/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand25%25%
  • QL 6 per 30 days
BREYNA 160/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate3Preferred Brand25%25%
  • QL 10.3 per 30 days
BREYNA 80/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate3Preferred Brand25%25%
  • QL 10.3 per 30 days
BREZTRI 160/9/4.8 ug Aerosol, MeteredBudesonide, Glycopyrrolate, And Formoterol Fumarate3Preferred Brand25%25%
  • QL 10.7 per 30 days
BRIELLYN KitNorethindrone And Ethinyl Estradiol2Generic25%25%None
BRIMONIDINE 1 mg/mL Solution/ DropsBrimonidine Tartrate3Preferred Brand25%25%None
BRIMONIDINE TARTRATE 2 mg/mL Solution/ Drops2Generic25%25%None
BRIMONIDINE TARTRATE AND TIMOLOL MALEATE 2/5 mg/mL Solution/ Drops3Preferred Brand25%25%None
BRIMONIDINE TARTRATE OPHTHALMIC SOLUTION, 0.15% 1.5 mg/mL Solution/ Drops2Generic25%25%None
BRINSUPRI 10 mg TabletBrensocatib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
BRINSUPRI 25 mg TabletBrensocatib5Specialty Tier25%25%
  • PA
  • QL 31 per 31 days
BRINZOLAMIDE 10 mg/mL Suspension/ Drops4Non-Preferred Drug25%25%None
BRIVIACT 10 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BRIVIACT 10 mg/mL SolutionBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BRIVIACT 100 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BRIVIACT 25 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BRIVIACT 50 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BRIVIACT 75 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%25%
  • QL 62 per 31 days
BROMFENAC OPHTHALMIC SOLUTION 0.09% 1.035 mg/mL Solution/ Drops2Generic25%25%None
BROMOCRIPTINE MESYLATE 2.5 mg Tablet4Non-Preferred Drug25%25%None
BROMOCRIPTINE MESYLATE 5 mg Capsule4Non-Preferred Drug25%25%None
BRUKINSA 160 mg Tablet, Film CoatedZanubrutinib5Specialty Tier25%25%
  • PA
  • QL 62 per 31 days
BUDESONIDE .25 mg/2mL Suspension4Non-Preferred Drug25%25%
  • PA
BUDESONIDE .5 mg/2mL Suspension4Non-Preferred Drug25%25%
  • PA
BUDESONIDE 3 mg Capsule, Delayed Release4Non-Preferred Drug25%25%None
BUDESONIDE 9 mg Tablet, Extended Release5Specialty Tier25%25%None
BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE 160/4.5 ug Aerosol3Preferred Brand25%25%
  • QL 10.2 per 30 days
BUDESONIDE AND FORMOTEROL FUMARATE DIHYDRATE 80/4.5 ug Aerosol3Preferred Brand25%25%
  • QL 10.2 per 30 days
BUDESONIDE INHALATION SUSPENSION 1 mg/2mL InhalantBudesonide4Non-Preferred Drug25%25%
  • PA
BUMETANIDE .25 mg/mL Injection, Solution2Generic25%25%None
BUMETANIDE .5 mg Tablet2Generic25%25%None
BUMETANIDE 1 mg Tablet2Generic25%25%None
BUMETANIDE 2 mg Tablet2Generic25%25%None
BUPRENORPHINE 10 ug/h Patch, Extended Release4Non-Preferred Drug25%25%
  • PA
  • QL 4 per 28 days
BUPRENORPHINE 15 ug/h Patch, Extended Release4Non-Preferred Drug25%25%
  • PA
  • QL 4 per 28 days
BUPRENORPHINE 2 mg Tablet3Preferred Brand25%25%None
BUPRENORPHINE 20 ug/h Patch, Extended Release4Non-Preferred Drug25%25%
  • PA
  • QL 4 per 28 days
BUPRENORPHINE 5 ug/h Patch, Extended Release4Non-Preferred Drug25%25%
  • PA
  • QL 4 per 28 days
BUPRENORPHINE 7.5 ug/h Patch, Extended Release4Non-Preferred Drug25%25%
  • PA
  • QL 4 per 28 days
BUPRENORPHINE 8 mg Tablet3Preferred Brand25%25%None
BUPRENORPHINE AND NALOXONE 2/.5 mg Tablet4Non-Preferred Drug25%25%None
BUPRENORPHINE AND NALOXONE 8/2 mg Tablet4Non-Preferred Drug25%25%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 12/3 mg FilmBuprenorphine And Naloxone2Generic25%25%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 2/.5 mg FilmBuprenorphine And Naloxone2Generic25%25%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 4/1 mg FilmBuprenorphine And Naloxone2Generic25%25%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 8/2 mg FilmBuprenorphine And Naloxone2Generic25%25%None
BUPROPION HYDROCHLORIDE 100 mg Tablet, Film Coated2Generic25%25%None
BUPROPION HYDROCHLORIDE 75 mg Tablet, Film Coated2Generic25%25%None
BUPROPION HYDROCHLORIDE SR 100 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 62 per 31 days
BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 62 per 31 days
BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 62 per 31 days
BUPROPION HYDROCHLORIDE SR 200 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 62 per 31 days
BUPROPION HYDROCHLORIDE XL 150 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 93 per 31 days
BUPROPION HYDROCHLORIDE XL 300 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic25%25%
  • QL 31 per 31 days
BUSPIRONE HYDROCHLORIDE 10 mg Tablet2Generic25%25%None
BUSPIRONE HYDROCHLORIDE 15 mg Tablet2Generic25%25%None
BUSPIRONE HYDROCHLORIDE 30 mg Tablet2Generic25%25%None
BUSPIRONE HYDROCHLORIDE 5 mg Tablet2Generic25%25%None
BUSPIRONE HYDROCHLORIDE 7.5 mg Tablet2Generic25%25%None
BUTALBITAL AND ACETAMINOPHEN 50/325 mg Tablet2Generic25%25%
  • QL 372 per 31 days
BUTALBITAL, ACETAMINOPHEN AND CAFFEINE 300/40/50 mg Capsule4Non-Preferred Drug25%25%
  • QL 403 per 31 days
BUTALBITAL, ACETAMINOPHEN AND CAFFEINE 50/325/40 mg Capsule4Non-Preferred Drug25%25%
  • QL 372 per 31 days
BUTALBITAL, ACETAMINOPHEN, AND CAFFEINE 50/325/40 mg Tablet4Non-Preferred Drug25%25%
  • QL 372 per 31 days
BUTALBITAL, ACETAMINOPHEN, CAFFEINE AND CODEINE PHOSPHATE 50/325/40/30 mg Capsule4Non-Preferred Drug25%25%
  • PA
  • QL 372 per 31 days
BUTALBITAL, ACETAMINOPHEN, CAFFEINE, AND CODEINE PHOSPHATE 50/300/40/30 mg Capsule4Non-Preferred Drug25%25%
  • PA
  • QL 403 per 31 days
BUTORPHANOL TARTRATE 10 mg/mL Spray, Metered2Generic25%25%
  • QL 5 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.