MedicarePartD.guide

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2026 BlueCross Rx Value (PDP) formulary (drug list)

Contract S5953, plan 001 · South Carolina · 3,082 drugs on file · formulary ID 00026220. Each drug links to its cost in every CMS PDP Region 09 plan.

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129 drugs starting with B.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
BACITRACIN ZINC AND POLYMYXIN B SULFATE 500/10000 [USP'U]/g Ointment3Preferred Brand17%17%None
BACLOFEN 10 mg Tablet2Generic$17.00$42.50None
BACLOFEN 20 mg Tablet2Generic$17.00$42.50None
BACLOFEN 5 mg Tablet3Preferred Brand17%17%None
BALSALAZIDE DISODIUM 750 mg Capsule4Non-Preferred Drug50%50%None
BALVERSA 3 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%N/A
  • PA
BALVERSA 4 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%N/A
  • PA
BALVERSA 5 mg Tablet, Film CoatedErdafitinib5Specialty Tier25%N/A
  • PA
BALZIVA KitNorethindrone And Ethinyl Estradiol3Preferred Brand17%17%None
BAQSIMI 3 mg PowderGlucagon3Preferred Brand17%17%None
BARACLUDE .05 mg/mL SolutionEntecavir4Non-Preferred Drug50%50%
  • QL 6 per 30 days
BCG VACCINE 50 mg Injection, Powder, Lyophilized, For SolutionBacillus Calmette-Guerin Substrain Tice Live Antigen1Preferred Generic$12.00$30.00None
BELSOMRA 10 mg Tablet, Film CoatedSuvorexant3Preferred Brand17%17%
  • QL 3 per 30 days
BELSOMRA 15 mg Tablet, Film CoatedSuvorexant3Preferred Brand17%17%
  • QL 3 per 30 days
BELSOMRA 20 mg Tablet, Film CoatedSuvorexant3Preferred Brand17%17%
  • QL 3 per 30 days
BELSOMRA 5 mg Tablet, Film CoatedSuvorexant3Preferred Brand17%17%
  • QL 3 per 30 days
BENAZEPRIL HYDROCHLORIDE 10 mg Tablet, Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE 20 mg Tablet, Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE 40 mg Tablet, Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE 5 mg Tablet, Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 20/25 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
BENAZEPRIL HYDROCHLORIDE AND HYDROCHLOROTHIAZIDE 5/6.25 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
BENLYSTA 200 mg/mL SolutionBelimumab5Specialty Tier25%N/A
  • PA
BENLYSTA 200 mg/mL SolutionBelimumab5Specialty Tier25%N/A
  • PA
BENZTROPINE MESYLATE .5 mg Tablet2Generic$17.00$42.50None
BENZTROPINE MESYLATE 1 mg Tablet2Generic$17.00$42.50None
BENZTROPINE MESYLATE 2 mg Tablet2Generic$17.00$42.50None
BESIVANCE 6 mg/mL SuspensionBesifloxacin4Non-Preferred Drug50%50%None
BESREMI 500 ug/mL InjectionRopeginterferon Alfa-2B5Specialty Tier25%N/A
  • PA
BETAINE 1 g/g Powder, For Solution5Specialty Tier25%N/ANone
BETAMETHASONE DIPROPIONATE .5 mg/g Cream3Preferred Brand17%17%None
BETAMETHASONE DIPROPIONATE .5 mg/g Cream, Augmented2Generic$17.00$42.50None
BETAMETHASONE DIPROPIONATE .5 mg/g Lotion3Preferred Brand17%17%None
BETAMETHASONE DIPROPIONATE .5 mg/g Ointment4Non-Preferred Drug50%50%None
BETAMETHASONE DIPROPIONATE .5 mg/g Ointment, Augmented4Non-Preferred Drug50%50%None
BETAMETHASONE VALERATE 1 mg/mL Lotion3Preferred Brand17%17%None
BETAMETHASONE VALERATE 1.2 mg/g Cream3Preferred Brand17%17%None
BETAMETHASONE VALERATE 1.2 mg/g Ointment3Preferred Brand17%17%None
BETASERON KitInterferon Beta-1B5Specialty Tier25%N/A
  • PA
  • QL 15 per 30 days
BETAXOLOL HYDROCHLORIDE 10 mg Tablet, Coated3Preferred Brand17%17%None
BETAXOLOL HYDROCHLORIDE 20 mg Tablet, Coated3Preferred Brand17%17%None
BETAXOLOL HYDROCHLORIDE 5.6 mg/mL Solution/ Drops3Preferred Brand17%17%None
BETHANECHOL CHLORIDE 10 mg Tablet3Preferred Brand17%17%None
BETHANECHOL CHLORIDE 25 mg Tablet3Preferred Brand17%17%None
BETHANECHOL CHLORIDE 5 mg Tablet3Preferred Brand17%17%None
BETHANECHOL CHLORIDE 50 mg Tablet3Preferred Brand17%17%None
BEXAROTENE 10 mg/g Gel5Specialty Tier25%N/A
  • PA
BEXAROTENE 75 mg Capsule, Liquid Filled5Specialty Tier25%N/A
  • 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 Antigen1Preferred Generic$12.00$30.00None
BICALUTAMIDE 50 mg Tablet3Preferred Brand17%17%None
BICILLIN L-A 1200000 [iU]/2mL Injection, SuspensionPenicillin G Benzathine4Non-Preferred Drug50%50%None
BICILLIN L-A 2400000 [iU]/4mL Injection, SuspensionPenicillin G Benzathine4Non-Preferred Drug50%50%None
BICILLIN L-A 600000 [iU]/mL Injection, SuspensionPenicillin G Benzathine4Non-Preferred Drug50%50%None
BIKTARVY 30/120/15 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate5Specialty Tier25%N/A
  • QL 3 per 30 days
BIKTARVY 50/200/25 mg TabletBictegravir Sodium, Emtricitabine, And Tenofovir Alafenamide Fumarate5Specialty Tier25%N/A
  • QL 3 per 30 days
BISOPROLOL FUMARATE 10 mg Tablet2Generic$17.00$42.50None
BISOPROLOL FUMARATE 5 mg Tablet2Generic$17.00$42.50None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/10 mg Tablet2Generic$17.00$42.50None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/2.5 mg Tablet2Generic$17.00$42.50None
BISOPROLOL FUMARATE AND HYDROCHLOROTHIAZIDE 6.25/5 mg Tablet2Generic$17.00$42.50None
BIVIGAM 5 g/50mL Injection, SolutionImmune Globulin Intravenous (Human) 10%5Specialty Tier25%N/A
  • PA
BLISOVI FE 1.5/30 KitNorethindrone Acetate And Ethinyl Estradiol3Preferred Brand17%17%None
BONSITY 250 ug/mL Injection, SolutionTeriparatide5Specialty Tier25%N/A
  • PA
BOOSTRIX 5/2.5/8/8/2.5 [iU]/.5mL/ug/.5mL SuspensionTetanus Toxoid, Reduced Diphtheria Toxoid And Acellular Pertussis Vaccine, Adsorbed1Preferred Generic$12.00$30.00None
BOSENTAN 125 mg Tablet, Coated5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
BOSENTAN 62.5 mg Tablet, Coated5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
BOSULIF 100 mg CapsuleBosutinib5Specialty Tier25%N/A
  • PA
BOSULIF 100 mg Tablet, Film CoatedBosutinib5Specialty Tier25%N/A
  • PA
BOSULIF 400 mg Tablet, Film CoatedBosutinib5Specialty Tier25%N/A
  • PA
BOSULIF 50 mg CapsuleBosutinib5Specialty Tier25%N/A
  • PA
BOSULIF 500 mg Tablet, Film CoatedBosutinib5Specialty Tier25%N/A
  • PA
BRAFTOVI 75 mg CapsuleEncorafenib5Specialty Tier25%N/A
  • PA
BREO ELLIPTA 100/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand17%17%
  • QL 6 per 30 days
BREO ELLIPTA 200/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand17%17%
  • QL 6 per 30 days
BREO ELLIPTA 50/25 ug PowderFluticasone Furoate And Vilanterol Trifenatate3Preferred Brand17%17%
  • QL 6 per 30 days
BREYNA 160/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate4Non-Preferred Drug50%50%
  • QL 10.3 per 30 days
BREYNA 80/4.5 ug Aerosol, MeteredBudesonide And Formoterol Fumarate4Non-Preferred Drug50%50%
  • QL 10.3 per 30 days
BREZTRI 160/9/4.8 ug Aerosol, MeteredBudesonide, Glycopyrrolate, And Formoterol Fumarate3Preferred Brand17%17%
  • QL 23.6 per 28 days
BRIELLYN KitNorethindrone And Ethinyl Estradiol3Preferred Brand17%17%None
BRIMONIDINE 1 mg/mL Solution/ DropsBrimonidine Tartrate3Preferred Brand17%17%None
BRIMONIDINE TARTRATE 2 mg/mL Solution/ Drops2Generic$17.00$42.50None
BRIMONIDINE TARTRATE AND TIMOLOL MALEATE 2/5 mg/mL Solution/ Drops4Non-Preferred Drug50%50%None
BRIVIACT 10 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%N/A
  • PA
BRIVIACT 10 mg/mL SolutionBrivaracetam5Specialty Tier25%N/A
  • PA
BRIVIACT 100 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%N/A
  • PA
BRIVIACT 25 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%N/A
  • PA
BRIVIACT 50 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%N/A
  • PA
BRIVIACT 75 mg Tablet, Film CoatedBrivaracetam5Specialty Tier25%N/A
  • PA
BROMFENAC OPHTHALMIC SOLUTION, 0.07% .7 mg/mL Solution/ DropsBromfenac Sodium4Non-Preferred Drug50%50%
  • QL 12 per 365 days
BROMOCRIPTINE MESYLATE 2.5 mg Tablet4Non-Preferred Drug50%50%None
BROMOCRIPTINE MESYLATE 5 mg Capsule4Non-Preferred Drug50%50%None
BRUKINSA 160 mg Tablet, Film CoatedZanubrutinib5Specialty Tier25%N/A
  • PA
BUDESONIDE .25 mg/2mL Suspension4Non-Preferred Drug50%50%
  • PA
  • QL 12 per 30 days
BUDESONIDE .5 mg/2mL Suspension4Non-Preferred Drug50%50%
  • PA
  • QL 12 per 30 days
BUDESONIDE 3 mg Capsule, Delayed Release4Non-Preferred Drug50%50%None
BUDESONIDE 9 mg Tablet, Extended Release5Specialty Tier25%N/ANone
BUDESONIDE INHALATION SUSPENSION 1 mg/2mL InhalantBudesonide4Non-Preferred Drug50%50%
  • PA
  • QL 12 per 30 days
BUMETANIDE .25 mg/mL Injection, Solution2Generic$17.00$42.50None
BUMETANIDE .5 mg Tablet3Preferred Brand17%17%None
BUMETANIDE 1 mg Tablet3Preferred Brand17%17%None
BUMETANIDE 2 mg Tablet3Preferred Brand17%17%None
BUPRENORPHINE 10 ug/h Patch, Extended Release4Non-Preferred Drug50%50%
  • QL 4 per 28 days
BUPRENORPHINE 15 ug/h Patch, Extended Release4Non-Preferred Drug50%50%
  • QL 4 per 28 days
BUPRENORPHINE 2 mg Tablet2Generic$17.00$42.50None
BUPRENORPHINE 20 ug/h Patch, Extended Release4Non-Preferred Drug50%50%
  • QL 4 per 28 days
BUPRENORPHINE 5 ug/h Patch, Extended Release4Non-Preferred Drug50%50%
  • QL 4 per 28 days
BUPRENORPHINE 7.5 ug/h Patch, Extended Release4Non-Preferred Drug50%50%
  • QL 4 per 28 days
BUPRENORPHINE 8 mg Tablet2Generic$17.00$42.50None
BUPRENORPHINE AND NALOXONE 2/.5 mg Tablet2Generic$17.00$42.50None
BUPRENORPHINE AND NALOXONE 8/2 mg Tablet2Generic$17.00$42.50None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 12/3 mg FilmBuprenorphine And Naloxone3Preferred Brand17%17%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 2/.5 mg FilmBuprenorphine And Naloxone3Preferred Brand17%17%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 4/1 mg FilmBuprenorphine And Naloxone3Preferred Brand17%17%None
BUPRENORPHINE AND NALOXONE SUBLINGUAL FILM 8/2 mg FilmBuprenorphine And Naloxone3Preferred Brand17%17%None
BUPROPION HYDROCHLORIDE 100 mg Tablet, Film Coated2Generic$17.00$42.50None
BUPROPION HYDROCHLORIDE 75 mg Tablet, Film Coated2Generic$17.00$42.50None
BUPROPION HYDROCHLORIDE SR 100 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 9 per 30 days
BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 6 per 30 days
BUPROPION HYDROCHLORIDE SR 150 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 6 per 30 days
BUPROPION HYDROCHLORIDE SR 200 mg Tablet, Film Coated, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 6 per 30 days
BUPROPION HYDROCHLORIDE XL 150 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 9 per 30 days
BUPROPION HYDROCHLORIDE XL 300 mg Tablet, Extended ReleaseBupropion Hydrochloride2Generic$17.00$42.50
  • QL 3 per 30 days
BUSPIRONE HYDROCHLORIDE 10 mg Tablet2Generic$17.00$42.50None
BUSPIRONE HYDROCHLORIDE 15 mg Tablet2Generic$17.00$42.50None
BUSPIRONE HYDROCHLORIDE 30 mg Tablet2Generic$17.00$42.50None
BUSPIRONE HYDROCHLORIDE 5 mg Tablet2Generic$17.00$42.50None
BUSPIRONE HYDROCHLORIDE 7.5 mg Tablet2Generic$17.00$42.50None

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.