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.
130 drugs starting with F.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| FALMINA KitLevonorgestrel And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| FAMCICLOVIR 125 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| FAMCICLOVIR 250 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| FAMCICLOVIR 500 mg Tablet, Film Coated | 3Preferred Brand | 17% | 17% | None |
| FAMOTIDINE 20 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| FAMOTIDINE 40 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | 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 | 50% | 50% |
|
| FARXIGA 10 mg Tablet, Film CoatedDapagliflozin | 3Preferred Brand | 17% | 17% |
|
| FARXIGA 5 mg Tablet, Film CoatedDapagliflozin | 3Preferred Brand | 17% | 17% |
|
| FEIRZA 1.5/30 TM KitNorethindrone Acetate And Ethinyl Estradiol Tablets Usp, 1.5 Mg/30 Mcg And Ferrous Fumarate Tablets, 75 Mg | 3Preferred Brand | 17% | 17% | None |
| FEIRZA 1/20 KitNorethindrone Acetate And Ethinyl Estradiol Tablets Usp, 1 Mg/0.02 Mg And Ferrous Fumarate Tablets, 75 Mg | 3Preferred Brand | 17% | 17% | None |
| FELBAMATE 400 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| FELBAMATE 600 mg Tablet | 4Non-Preferred Drug | 50% | 50% | None |
| FELBAMATE 600 mg/5mL Suspension | 4Non-Preferred Drug | 50% | 50% | None |
| FELODIPINE 10 mg Tablet, Extended Release | 2Generic | $17.00 | $42.50 | None |
| FELODIPINE 2.5 mg Tablet, Extended Release | 2Generic | $17.00 | $42.50 | None |
| FELODIPINE 5 mg Tablet, Extended Release | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 134 mg Capsule | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 145 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 160 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 200 mg Capsule | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 48 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 54 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FENOFIBRATE 67 mg Capsule | 2Generic | $17.00 | $42.50 | None |
| FENTANYL 100 ug/h Patch | 4Non-Preferred Drug | 50% | 50% | None |
| FENTANYL 25 ug/h Patch | 4Non-Preferred Drug | 50% | 50% | None |
| FENTANYL 50 ug/h Patch | 4Non-Preferred Drug | 50% | 50% | None |
| FENTANYL 75 ug/h Patch | 4Non-Preferred Drug | 50% | 50% | None |
| FETZIMA 120 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 50% | 50% |
|
| FETZIMA 20 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 50% | 50% |
|
| FETZIMA 40 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 50% | 50% |
|
| FETZIMA 80 mg Capsule, Extended ReleaseLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 50% | 50% |
|
| FETZIMA KitLevomilnacipran Hydrochloride | 4Non-Preferred Drug | 50% | 50% |
|
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 17% | 17% | None |
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 17% | 17% | None |
| FIASP 100 [iU]/mL Injection, SolutionInsulin Aspart Injection | 3Preferred Brand | 17% | 17% | None |
| FIDAXOMICIN 200 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| FINACEA FOAM .15 g/g Aerosol, FoamAzelaic Acid | 4Non-Preferred Drug | 50% | 50% |
|
| FINASTERIDE 5 mg Tablet, Film Coated | 2Generic | $17.00 | $42.50 | None |
| FINGOLIMOD HYDROCHLORIDE .5 mg Capsule | 5Specialty Tier | 25% | N/A |
|
| FINTEPLA 2.2 mg/mL SolutionFenfluramine | 5Specialty Tier | 25% | N/A |
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| FIRMAGON KitDegarelix | 4Non-Preferred Drug | 50% | 50% |
|
| FIRMAGON KitDegarelix | 5Specialty Tier | 25% | N/A |
|
| FLECAINIDE ACETATE 100 mg TabletFlecainide Acetate Tablet | 3Preferred Brand | 17% | 17% | None |
| FLECAINIDE ACETATE 150 mg TabletFlecainide Acetate Tablet | 3Preferred Brand | 17% | 17% | None |
| FLECAINIDE ACETATE 50 mg TabletFlecainide Acetate Tablet | 3Preferred Brand | 17% | 17% | None |
| FLUCONAZOLE 10 mg/mL Powder, For Suspension | 3Preferred Brand | 17% | 17% | None |
| FLUCONAZOLE 100 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FLUCONAZOLE 150 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FLUCONAZOLE 2 mg/mL Injection, Solution | 3Preferred Brand | 17% | 17% | None |
| FLUCONAZOLE 2 mg/mL Injection, Solution | 3Preferred Brand | 17% | 17% | None |
| FLUCONAZOLE 200 mg Tablet | 2Generic | $17.00 | $42.50 | None |
| FLUCONAZOLE 40 mg/mL Powder, For Suspension | 3Preferred Brand | 17% | 17% | None |
| FLUCONAZOLE 50 mg Tablet | 2Generic | $17.00 | $42.50 | 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 | $17.00 | $42.50 | None |
| FLUOCINOLONE ACETONIDE .1 mg/g Cream | 3Preferred Brand | 17% | 17% | None |
| FLUOCINOLONE ACETONIDE .1 mg/mL Solution | 3Preferred Brand | 17% | 17% | None |
| FLUOCINOLONE ACETONIDE .25 mg/g Cream | 3Preferred Brand | 17% | 17% | None |
| FLUOCINOLONE ACETONIDE .25 mg/g Ointment | 3Preferred Brand | 17% | 17% | None |
| FLUOCINONIDE .5 mg/g Cream | 3Preferred Brand | 17% | 17% |
|
| FLUOCINONIDE .5 mg/g Gel | 3Preferred Brand | 17% | 17% |
|
| FLUOCINONIDE .5 mg/g Ointment | 3Preferred Brand | 17% | 17% |
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| FLUOCINONIDE .5 mg/mL SolutionFluocinonide Topical Solution Usp, 0.05% | 3Preferred Brand | 17% | 17% |
|
| FLUOCINONIDE 1 mg/g Cream | 3Preferred Brand | 17% | 17% |
|
| FLUOROMETHOLONE OPHTHALMIC SUSPENSION 1 mg/mL Suspension/ DropsFluorometholone | 3Preferred Brand | 17% | 17% | None |
| FLUOROURACIL 20 mg/mL Solution | 3Preferred Brand | 17% | 17% | None |
| FLUOROURACIL 5 mg/g CreamFluorouracil Cream, 0.5% | 4Non-Preferred Drug | 50% | 50% | None |
| FLUOROURACIL 50 mg/g Cream | 4Non-Preferred Drug | 50% | 50% |
|
| FLUOROURACIL 50 mg/mL Solution | 3Preferred Brand | 17% | 17% | None |
| FLUOXETINE 10 mg Capsule | 1Preferred Generic | $12.00 | $30.00 | None |
| FLUOXETINE 20 mg Capsule | 1Preferred Generic | $12.00 | $30.00 | None |
| FLUOXETINE 20 mg/5mL Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FLUOXETINE 40 mg Capsule | 1Preferred Generic | $12.00 | $30.00 | None |
| FLUPHENAZINE DECANOATE 25 mg/mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE .5 mg/mL Elixir | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 1 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 10 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 2.5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 2.5 mg/mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 5 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% | None |
| FLUPHENAZINE HYDROCHLORIDE 5 mg/mL Solution, Concentrate | 4Non-Preferred Drug | 50% | 50% | None |
| FLURBIPROFEN 100 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| FLURBIPROFEN SODIUM .3 mg/mL Solution/ Drops | 2Generic | $17.00 | $42.50 | None |
| FLUTICASONE PROPIONATE .05 mg/g Ointment | 3Preferred Brand | 17% | 17% | None |
| FLUTICASONE PROPIONATE .5 mg/g Cream | 3Preferred Brand | 17% | 17% | None |
| FLUTICASONE PROPIONATE 50 ug Spray, Metered | 2Generic | $17.00 | $42.50 | None |
| FLUTICASONE PROPIONATE AND SALMETEROL 50/500 ug Powder | 3Preferred Brand | 17% | 17% |
|
| FLUTICASONE PROPIONATE AND SALMETEROL DISKUS 100/50 ug PowderFluticasone Propionate And Salmeterol | 3Preferred Brand | 17% | 17% |
|
| FLUTICASONE PROPIONATE AND SALMETEROL DISKUS 250/50 ug PowderFluticasone Propionate And Salmeterol | 3Preferred Brand | 17% | 17% |
|
| FLUVOXAMINE MALEATE 100 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| FLUVOXAMINE MALEATE 25 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| FLUVOXAMINE MALEATE 50 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| FONDAPARINUX SODIUM 10 mg/.8mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FONDAPARINUX SODIUM 2.5 mg/.5mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FONDAPARINUX SODIUM 5 mg/.4mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FONDAPARINUX SODIUM 7.5 mg/.6mL Injection, Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FORTEO 250 ug/mL Injection, SolutionTeriparatide | 5Specialty Tier | 25% | N/A |
|
| FOSAMPRENAVIR CALCIUM 700 mg Tablet, Film Coated | 5Specialty Tier | 25% | N/A |
|
| FOSFOMYCIN TROMETHAMINE 3 g PowderGranules For Oral Solution | 4Non-Preferred Drug | 50% | 50% | None |
| FOSINOPRIL SODIUM 10 mg TabletFosinopirl Sodium | 6Select Care Drugs | $5.00 | $12.50 | None |
| FOSINOPRIL SODIUM 20 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| FOSINOPRIL SODIUM 40 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| FOSINOPRIL SODIUM AND HYDROCHLOROTHIAZIDE 10/12.5 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | None |
| FOSINOPRIL SODIUM AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet | 6Select Care Drugs | $5.00 | $12.50 | 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 | 3Preferred Brand | 17% | 17% | None |
| FUROSEMIDE 10 mg/mL Solution | 1Preferred Generic | $12.00 | $30.00 | None |
| FUROSEMIDE 20 mg Tablet | 1Preferred Generic | $12.00 | $30.00 | None |
| FUROSEMIDE 40 mg Tablet | 1Preferred Generic | $12.00 | $30.00 | None |
| FUROSEMIDE 40 mg/5mL Solution | 1Preferred Generic | $12.00 | $30.00 | None |
| FUROSEMIDE 80 mg Tablet | 1Preferred Generic | $12.00 | $30.00 | None |
| FYAVOLV .0025/.5 mg Tablet, Film CoatedNorethindrone Acetate And Ethinyl Estradiol | 4Non-Preferred Drug | 50% | 50% | None |
| FYAVOLV .005/1 mg Tablet, Film CoatedNorethindrone Acetate And Ethinyl Estradiol | 3Preferred Brand | 17% | 17% | None |
| FYCOMPA .5 mg/mL SuspensionPerampanel | 5Specialty Tier | 25% | N/A | None |
| FYCOMPA 10 mg TabletPerampanel | 5Specialty Tier | 25% | N/A | None |
| FYCOMPA 12 mg TabletPerampanel | 5Specialty Tier | 25% | N/A | None |
| FYCOMPA 2 mg TabletPerampanel | 4Non-Preferred Drug | 50% | 50% | None |
| FYCOMPA 4 mg TabletPerampanel | 5Specialty Tier | 25% | N/A | None |
| FYCOMPA 6 mg TabletPerampanel | 5Specialty Tier | 25% | N/A | None |
| FYCOMPA 8 mg TabletPerampanel | 5Specialty Tier | 25% | N/A | None |
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.