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.

83 drugs starting with H.

Drug name	Tier	30-day preferred pharmacy	90-day mail order	Usage management
HAILEY FE 1/20 KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate	3Preferred Brand	17%	17%	None
HALOBETASOL PROPIONATE .5 mg/g Ointment	4Non-Preferred Drug	50%	50%	None
HALOPERIDOL .5 mg Tablet	2Generic	$17.00	$42.50	None
HALOPERIDOL 1 mg Tablet	2Generic	$17.00	$42.50	None
HALOPERIDOL 10 mg Tablet	2Generic	$17.00	$42.50	None
HALOPERIDOL 2 mg Tablet	2Generic	$17.00	$42.50	None
HALOPERIDOL 2 mg/mL Solution	2Generic	$17.00	$42.50	None
HALOPERIDOL 20 mg Tablet	3Preferred Brand	17%	17%	None
HALOPERIDOL 5 mg Tablet	2Generic	$17.00	$42.50	None
HALOPERIDOL 5 mg/mL Injection, SolutionHaloperidol Lactate	4Non-Preferred Drug	50%	50%	None
HALOPERIDOL DECANOATE 100 mg/mL Injection	4Non-Preferred Drug	50%	50%	None
HALOPERIDOL DECANOATE 50 mg/mL Injection	4Non-Preferred Drug	50%	50%	None
HALOPERIDOL DECANOATE 50 mg/mL Injection	4Non-Preferred Drug	50%	50%	None
HALOPERIDOL DECANOATE 500 mg/5mL Injection, Solution	4Non-Preferred Drug	50%	50%	None
HAVRIX 1440 [iU]/mL Injection, SuspensionHepatitis A Vaccine	1Preferred Generic	$12.00	$30.00	None
HAVRIX 720 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine	3Preferred Brand	17%	17%	None
HEATHER .35 mg TabletNorethindrone	3Preferred Brand	17%	17%	None
HEPARIN SODIUM 5000 [USP'U]/mL Injection, Solution	3Preferred Brand	17%	17%	None
HERNEXEOS 60 mg Tablet, Film CoatedZongertinib	5Specialty Tier	25%	N/A	PA
HIBERIX KitHaemophilus B Conjugate Vaccine (Tetanus Toxoid Conjugate)	1Preferred Generic	$12.00	$30.00	None
HUMALOG 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG JUNIOR KWIKPEN 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG KWIKPEN 100 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG KWIKPEN 200 [iU]/mL Injection, SolutionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG MIX50/50 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG MIX75/25 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMALOG MIX75/25 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Lispro	3Preferred Brand	17%	17%	None
HUMATIN 250 mg CapsuleParomomycin Sulfate	5Specialty Tier	25%	N/A	None
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 2 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 2 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 4 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 4 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 6 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 6 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 6 per 365 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 6 per 28 days
HUMIRA KitAdalimumab	5Specialty Tier	25%	N/A	PA QL 6 per 28 days
HUMULIN 70/30 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	17%	17%	None
HUMULIN 70/30 KWIKPEN 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	17%	17%	None
HUMULIN N 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	17%	17%	None
HUMULIN N 100 [iU]/mL Injection, SuspensionInsulin Human	3Preferred Brand	17%	17%	None
HUMULIN R 100 [iU]/mL Injection, SolutionInsulin Human	3Preferred Brand	17%	17%	None
HUMULIN R U-500 KWIKPEN 500 [iU]/mL Injection, SolutionInsulin Human	3Preferred Brand	17%	17%	None
HYDRALAZINE HYDROCHLORIDE 10 mg Tablet	2Generic	$17.00	$42.50	None
HYDRALAZINE HYDROCHLORIDE 100 mg Tablet	2Generic	$17.00	$42.50	None
HYDRALAZINE HYDROCHLORIDE 25 mg Tablet	2Generic	$17.00	$42.50	None
HYDRALAZINE HYDROCHLORIDE 50 mg Tablet	2Generic	$17.00	$42.50	None
HYDROCHLOROTHIAZIDE 12.5 mg Capsule	1Preferred Generic	$12.00	$30.00	None
HYDROCHLOROTHIAZIDE 12.5 mg Tablet	1Preferred Generic	$12.00	$30.00	None
HYDROCHLOROTHIAZIDE 25 mg Tablet	1Preferred Generic	$12.00	$30.00	None
HYDROCHLOROTHIAZIDE 50 mg Tablet	1Preferred Generic	$12.00	$30.00	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 10/325 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 2.5/325 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 5/325 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCODONE BITARTRATE AND ACETAMINOPHEN 7.5/325 mg/15mL Solution	3Preferred Brand	17%	17%	None
HYDROCORTISONE 10 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCORTISONE 10 mg/g Cream	2Generic	$17.00	$42.50	None
HYDROCORTISONE 10 mg/g Ointment	2Generic	$17.00	$42.50	QL 1 per 30 days
HYDROCORTISONE 100 mg/60mL Suspension	4Non-Preferred Drug	50%	50%	None
HYDROCORTISONE 20 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCORTISONE 25 mg/g Cream	2Generic	$17.00	$42.50	None
HYDROCORTISONE 25 mg/g Ointment	2Generic	$17.00	$42.50	None
HYDROCORTISONE 25 mg/mL Lotion	2Generic	$17.00	$42.50	None
HYDROCORTISONE 5 mg Tablet	3Preferred Brand	17%	17%	None
HYDROCORTISONE VALERATE 2 mg/g Cream	3Preferred Brand	17%	17%	QL 6 per 30 days
HYDROMORPHONE HYDROCHLORIDE 10 mg/mL Injection, Solution	4Non-Preferred Drug	50%	50%	None
HYDROMORPHONE HYDROCHLORIDE 10 mg/mL Injection, Solution	4Non-Preferred Drug	50%	50%	None
HYDROMORPHONE HYDROCHLORIDE 2 mg Tablet	2Generic	$17.00	$42.50	None
HYDROMORPHONE HYDROCHLORIDE 4 mg Tablet	2Generic	$17.00	$42.50	None
HYDROMORPHONE HYDROCHLORIDE 8 mg Tablet	4Non-Preferred Drug	50%	50%	None
HYDROXYCHLOROQUINE SULFATE 100 mg Tablet	3Preferred Brand	17%	17%	None
HYDROXYCHLOROQUINE SULFATE 200 mg Tablet, Film Coated	3Preferred Brand	17%	17%	None
HYDROXYUREA 500 mg Capsule	2Generic	$17.00	$42.50	None
HYDROXYZINE HYDROCHLORIDE 10 mg Tablet	3Preferred Brand	17%	17%	None
HYDROXYZINE HYDROCHLORIDE 10 mg/5mL Solution	4Non-Preferred Drug	50%	50%	None
HYDROXYZINE HYDROCHLORIDE 25 mg Tablet	3Preferred Brand	17%	17%	None
HYDROXYZINE HYDROCHLORIDE 50 mg Tablet	3Preferred Brand	17%	17%	None
HYDROXYZINE PAMOATE 100 mg Capsule	4Non-Preferred Drug	50%	50%	None
HYDROXYZINE PAMOATE 25 mg Capsule	4Non-Preferred Drug	50%	50%	None
HYDROXYZINE PAMOATE 50 mg Capsule	4Non-Preferred Drug	50%	50%	None
HYRNUO 10 mg Tablet, Film CoatedSevabertinib	5Specialty Tier	25%	N/A	PA

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.