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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162 drugs starting with E.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
ECONAZOLE NITRATE 10 mg/g Cream3Preferred Brand17%17%None
EDURANT 25 mg Tablet, Film CoatedRilpivirine Hydrochloride5Specialty Tier25%N/A
  • QL 3 per 30 days
EDURANT PED 2.5 mg Tablet, For SuspensionRilpivirine Hydrochloride5Specialty Tier25%N/A
  • QL 18 per 30 days
EFAVIRENZ 600 mg Tablet, Film Coated4Non-Preferred Drug50%50%
  • QL 3 per 30 days
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 600/200/300 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 400/300/300 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 3 per 30 days
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 600/300/300 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 3 per 30 days
ELIQUIS 2.5 mg Tablet, Film CoatedApixaban3Preferred Brand17%17%
  • QL 6 per 30 days
ELIQUIS 30-DAY STARTER PACK KitApixaban3Preferred Brand17%17%
  • QL 148 per 365 days
ELIQUIS 5 mg Tablet, Film CoatedApixaban3Preferred Brand17%17%
  • QL 9 per 30 days
ELMIRON 100 mg Capsule, Gelatin CoatedPentosan Polysulfate Sodium4Non-Preferred Drug50%50%None
ELTROMBOPAG 12.5 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier25%N/A
  • PA
ELTROMBOPAG 12.5 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
ELTROMBOPAG 25 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier25%N/A
  • PA
ELTROMBOPAG 25 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
ELTROMBOPAG 50 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
ELTROMBOPAG 75 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
ELURYNG .12/.015 mg/d RingEtonogestrel And Ethinyl Estradiol4Non-Preferred Drug50%50%None
EMGALITY 100 mg/mL Injection, SolutionGalcanezumab-Gnlm5Specialty Tier25%N/A
  • PA
  • QL 3 per 28 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand17%17%
  • PA
  • QL 2 per 28 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand17%17%
  • PA
  • QL 2 per 28 days
EMPAVELI 1080 mg/20mL Injection, SolutionPegcetacoplan5Specialty Tier25%N/A
  • PA
EMSAM 12 mg/24h PatchSelegiline4Non-Preferred Drug50%50%
  • ST
  • QL 3 per 30 days
EMSAM 6 mg/24h PatchSelegiline4Non-Preferred Drug50%50%
  • ST
  • QL 3 per 30 days
EMSAM 9 mg/24h PatchSelegiline4Non-Preferred Drug50%50%
  • ST
  • QL 3 per 30 days
EMTRICITABINE 200 mg Capsule4Non-Preferred Drug50%50%
  • QL 3 per 30 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 100/150 mg Tablet, Film Coated4Non-Preferred Drug50%50%
  • QL 3 per 30 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 133/200 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 3 per 30 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 167/250 mg Tablet, Film Coated4Non-Preferred Drug50%50%
  • QL 3 per 30 days
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 200/300 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
EMTRICITABINE, RILPIVIRINE, TENOFOVIR DISOPROXIL FUMARATE 200/25/300 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 3 per 30 days
EMTRIVA 10 mg/mL SolutionEmtricitabine4Non-Preferred Drug50%50%
  • QL 85 per 30 days
ENALAPRIL MALEATE 10 mg Tablet6Select Care Drugs$5.00$12.50None
ENALAPRIL MALEATE 2.5 mg Tablet6Select Care Drugs$5.00$12.50None
ENALAPRIL MALEATE 20 mg Tablet6Select Care Drugs$5.00$12.50None
ENALAPRIL MALEATE 5 mg Tablet6Select Care Drugs$5.00$12.50None
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 10/25 mg Tablet6Select Care Drugs$5.00$12.50None
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 5/12.5 mg Tablet6Select Care Drugs$5.00$12.50None
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENGERIX-B 10 ug/.5mL Injection, SuspensionHepatitis B Vaccine (Recombinant)1Preferred Generic$12.00$30.00
  • PA
ENGERIX-B 20 ug/mL Injection, SuspensionHepatitis B Vaccine (Recombinant)1Preferred Generic$12.00$30.00
  • PA
ENILLORING .015/.12 mg/d RingEtonogestrel And Ethinyl Estradiol Vaginal4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug50%50%None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug50%50%None
ENSACOVE 100 mg CapsuleEnsartinib5Specialty Tier25%N/A
  • PA
ENSACOVE 25 mg CapsuleEnsartinib5Specialty Tier25%N/A
  • PA
ENTACAPONE 200 mg Tablet3Preferred Brand17%17%None
ENTECAVIR .5 mg Tablet4Non-Preferred Drug50%50%
  • QL 3 per 30 days
ENTECAVIR 1 mg Tablet4Non-Preferred Drug50%50%
  • QL 3 per 30 days
ENTRESTO 15/16 mg PelletSacubitril And Valsartan3Preferred Brand17%17%
  • QL 24 per 30 days
ENTRESTO 6/6 mg PelletSacubitril And Valsartan3Preferred Brand17%17%
  • QL 24 per 30 days
ENULOSE 10 g/15mL SolutionLactulose2Generic$17.00$42.50None
ENVARSUS XR .75 mg Tablet, Extended ReleaseTacrolimus4Non-Preferred Drug50%50%
  • PA
ENVARSUS XR 1 mg Tablet, Extended ReleaseTacrolimus4Non-Preferred Drug50%50%
  • PA
ENVARSUS XR 4 mg Tablet, Extended ReleaseTacrolimus5Specialty Tier25%N/A
  • PA
EPIDIOLEX 100 mg/mL SolutionCannabidiol5Specialty Tier25%N/A
  • PA
EPINEPHRINE .15 mg/.15mL Injection3Preferred Brand17%17%None
EPINEPHRINE .15 mg/.3mL Injection3Preferred Brand17%17%None
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand17%17%None
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand17%17%None
EPLERENONE 25 mg Tablet, Film Coated3Preferred Brand17%17%None
EPLERENONE 50 mg Tablet, Film Coated3Preferred Brand17%17%None
EPRONTIA 25 mg/mL SolutionTopiramate4Non-Preferred Drug50%50%None
ERGOTAMINE TARTRATE AND CAFFEINE 1/100 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 24 per 28 days
ERIVEDGE 150 mg CapsuleVismodegib5Specialty Tier25%N/A
  • PA
ERLEADA 240 mg Tablet, Film CoatedApalutamide5Specialty Tier25%N/A
  • PA
ERLEADA 60 mg Tablet, Film CoatedApalutamide5Specialty Tier25%N/A
  • PA
ERLOTINIB 100 mg Tablet, Film Coated4Non-Preferred Drug50%50%
  • PA
ERLOTINIB 150 mg Tablet, Film Coated4Non-Preferred Drug50%50%
  • PA
ERLOTINIB 25 mg Tablet4Non-Preferred Drug50%50%
  • PA
ERTAPENEM 1 g/20mL InjectionErtapenem Sodium4Non-Preferred Drug50%50%None
ERY 20 mg/mL SwabErythromycin3Preferred Brand17%17%None
ERYTHROMYCIN 20 mg/g Gel4Non-Preferred Drug50%50%None
ERYTHROMYCIN 20 mg/mL Solution3Preferred Brand17%17%None
ERYTHROMYCIN 250 mg Tablet, Delayed Release4Non-Preferred Drug50%50%None
ERYTHROMYCIN 333 mg Tablet, Delayed Release4Non-Preferred Drug50%50%None
ERYTHROMYCIN 5 mg/g Ointment2Generic$17.00$42.50None
ERYTHROMYCIN 500 mg Tablet, Delayed Release4Non-Preferred Drug50%50%None
ERYTHROMYCIN AND BENZOYL PEROXIDE 30/50 mg/g Gel4Non-Preferred Drug50%50%None
ESCITALOPRAM 10 mg Tablet, Film Coated2Generic$17.00$42.50None
ESCITALOPRAM 20 mg Tablet, Film Coated2Generic$17.00$42.50None
ESCITALOPRAM 5 mg Tablet, Film Coated2Generic$17.00$42.50None
ESCITALOPRAM OXALATE 5 mg/5mL SolutionEscitalopram4Non-Preferred Drug50%50%None
ESLICARBAZEPINE ACETATE 200 mg Tablet4Non-Preferred Drug50%50%None
ESLICARBAZEPINE ACETATE 400 mg Tablet4Non-Preferred Drug50%50%None
ESLICARBAZEPINE ACETATE 600 mg Tablet4Non-Preferred Drug50%50%None
ESLICARBAZEPINE ACETATE 800 mg Tablet4Non-Preferred Drug50%50%None
ESOMEPRAZOLE MAGNESIUM 20 mg Capsule, Delayed Release3Preferred Brand17%17%
  • QL 6 per 30 days
ESOMEPRAZOLE MAGNESIUM 40 mg Capsule, Delayed Release3Preferred Brand17%17%
  • QL 6 per 30 days
ESTARYLLA KitNorgestimate And Ethinyl Estradiol3Preferred Brand17%17%None
ESTRADIOL .025 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .025 mg/d Patch4Non-Preferred Drug50%50%None
ESTRADIOL .0375 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .0375 mg/d Patch4Non-Preferred Drug50%50%None
ESTRADIOL .05 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .05 mg/d Patch4Non-Preferred Drug50%50%None
ESTRADIOL .06 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .075 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .075 mg/d Patch4Non-Preferred Drug50%50%None
ESTRADIOL .1 mg/d Patch3Preferred Brand17%17%None
ESTRADIOL .1 mg/d Patch4Non-Preferred Drug50%50%None
ESTRADIOL .25 mg/.25g GelEstradiol Gel 0.1%4Non-Preferred Drug50%50%None
ESTRADIOL .5 mg Tablet2Generic$17.00$42.50None
ESTRADIOL .5 mg/.5g GelEstradiol Gel 0.1%4Non-Preferred Drug50%50%None
ESTRADIOL .75 mg/.75g GelEstradiol Gel 0.1%4Non-Preferred Drug50%50%None
ESTRADIOL .75 mg/1.25g Gel4Non-Preferred Drug50%50%None
ESTRADIOL 1 mg Tablet2Generic$17.00$42.50None
ESTRADIOL 1 mg/g GelEstradiol Gel 0.1%4Non-Preferred Drug50%50%None
ESTRADIOL 1.25 mg/1.25g GelEstradiol Gel 0.1%4Non-Preferred Drug50%50%None
ESTRADIOL 10 ug Insert4Non-Preferred Drug50%50%None
ESTRADIOL 2 mg Tablet2Generic$17.00$42.50None
ESTRADIOL VAGINAL .1 mg/g CreamEstradiol4Non-Preferred Drug50%50%None
ESTRING 2 mg SystemEstradiol4Non-Preferred Drug50%50%
  • QL 1 per 90 days
ESTROGENS, CONJUGATED .3 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
ESTROGENS, CONJUGATED .45 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
ESTROGENS, CONJUGATED .625 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
ESTROGENS, CONJUGATED .9 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
ESTROGENS, CONJUGATED 1.25 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
ESZOPICLONE 1 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
ESZOPICLONE 2 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
ESZOPICLONE 3 mg Tablet, Film Coated3Preferred Brand17%17%
  • QL 3 per 30 days
ETHAMBUTOL HYDROCHLORIDE 100 mg Tablet3Preferred Brand17%17%None
ETHAMBUTOL HYDROCHLORIDE 400 mg Tablet3Preferred Brand17%17%None
ETHOSUXIMIDE 250 mg/5mL Solution3Preferred Brand17%17%None
ETONOGESTREL/ETHINYL ESTRADIOL .12/.015 mg/d Insert, Extended ReleaseEtonogestrel And Ethinyl Estradiol3Preferred Brand17%17%None
ETRAVIRINE 100 mg Tablet4Non-Preferred Drug50%50%
  • QL 6 per 30 days
ETRAVIRINE 200 mg Tablet5Specialty Tier25%N/A
  • QL 6 per 30 days
EUCRISA 20 mg/g OintmentCrisaborole4Non-Preferred Drug50%50%
  • PA
EULEXIN 125 mg CapsuleFlutamide4Non-Preferred Drug50%50%None
EVEROLIMUS .25 mg Tablet4Non-Preferred Drug50%50%
  • PA
EVEROLIMUS .5 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS .75 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS 1 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS 10 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
EVEROLIMUS 2 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
EVEROLIMUS 2.5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
EVEROLIMUS 3 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
EVEROLIMUS 5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
EVEROLIMUS 5 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
EVEROLIMUS 7.5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
EVOTAZ 300/150 mg TabletAtazanavir And Cobicistat5Specialty Tier25%N/A
  • QL 3 per 30 days
EVRYSDI .75 mg/mL Powder, For SolutionRisdiplam5Specialty Tier25%N/A
  • PA
  • QL 24 per 30 days
EXEMESTANE 25 mg Tablet4Non-Preferred Drug50%50%None
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone5Specialty Tier25%N/A
  • ST
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone5Specialty Tier25%N/A
  • ST
EXXUA 36.3 mg Tablet, Extended ReleaseGepirone5Specialty Tier25%N/A
  • ST
  • QL 3 per 30 days
EXXUA 54.5 mg Tablet, Extended ReleaseGepirone5Specialty Tier25%N/A
  • ST
  • QL 3 per 30 days
EXXUA 72.6 mg Tablet, Extended ReleaseGepirone5Specialty Tier25%N/A
  • ST
  • QL 3 per 30 days
EZETIMIBE 10 mg Tablet2Generic$17.00$42.50None
EZETIMIBE AND SIMVASTATIN 10/10 mg Tablet6Select Care Drugs$5.00$12.50None
EZETIMIBE AND SIMVASTATIN 10/20 mg Tablet6Select Care Drugs$5.00$12.50None
EZETIMIBE AND SIMVASTATIN 10/40 mg Tablet6Select Care Drugs$5.00$12.50None
EZETIMIBE AND SIMVASTATIN 10/80 mg Tablet6Select Care Drugs$5.00$12.50None

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.