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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106 drugs starting with O.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug50%50%
  • PA
OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug50%50%
  • PA
OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug50%50%
  • PA
OCTREOTIDE ACETATE 200 ug/mL Injection, Solution4Non-Preferred Drug50%50%
  • PA
OCTREOTIDE ACETATE 50 ug/mL Injection, Solution4Non-Preferred Drug50%50%
  • PA
ODACTRA 6/6 [arb'U] TabletDermatophagoides Pteronyssinus And Dermatophagoides Farinae3Preferred Brand17%17%
  • PA
  • QL 3 per 30 days
ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide5Specialty Tier25%N/A
  • QL 3 per 30 days
ODOMZO 200 mg CapsuleSonidegib5Specialty Tier25%N/A
  • PA
OFEV 100 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
OFEV 150 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
OFLOXACIN 3 mg/mL Solution2Generic$17.00$42.50None
OFLOXACIN 3 mg/mL SolutionOfloxacin Otic3Preferred Brand17%17%None
OGSIVEO 100 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
OGSIVEO 150 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
OJEMDA KitTovorafenib5Specialty Tier25%N/A
  • PA
OJJAARA 100 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
OJJAARA 150 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OJJAARA 200 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
OLANZAPINE 10 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLANZAPINE 10 mg Tablet, Orally Disintegrating4Non-Preferred Drug50%50%
  • QL 3 per 30 days
OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug50%50%None
OLANZAPINE 15 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLANZAPINE 15 mg Tablet, Orally Disintegrating4Non-Preferred Drug50%50%
  • QL 3 per 30 days
OLANZAPINE 2.5 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLANZAPINE 20 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLANZAPINE 20 mg Tablet, Orally Disintegrating4Non-Preferred Drug50%50%
  • QL 3 per 30 days
OLANZAPINE 5 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLANZAPINE 5 mg Tablet, Orally Disintegrating4Non-Preferred Drug50%50%
  • QL 3 per 30 days
OLANZAPINE 7.5 mg Tablet, Film Coated2Generic$17.00$42.50
  • QL 3 per 30 days
OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated6Select Care Drugs$5.00$12.50None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet6Select Care Drugs$5.00$12.50None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet6Select Care Drugs$5.00$12.50None
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet6Select Care Drugs$5.00$12.50None
OMEGA-3-ACID ETHYL ESTERS 900 mg Capsule4Non-Preferred Drug50%50%None
OMEPRAZOLE 10 mg Capsule, Delayed Release2Generic$17.00$42.50
  • QL 6 per 30 days
OMEPRAZOLE 20 mg Capsule, Delayed Release2Generic$17.00$42.50
  • QL 6 per 30 days
OMEPRAZOLE 40 mg Capsule, Delayed Release2Generic$17.00$42.50
  • QL 6 per 30 days
ONDANSETRON 4 mg Tablet, Orally Disintegrating3Preferred Brand17%17%
  • PA
ONDANSETRON 8 mg Tablet, Orally Disintegrating3Preferred Brand17%17%
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated2Generic$17.00$42.50
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg/5mL Solution4Non-Preferred Drug50%50%
  • PA
  • QL 45 per 30 days
ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated2Generic$17.00$42.50
  • PA
ONUREG 200 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
ONUREG 300 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
OPIPZA 10 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
OPIPZA 2 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OPIPZA 5 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
OPSUMIT 10 mg Tablet, Film CoatedMacitentan5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OPVEE 2.7 mg/100uL SprayNalmefene Hydrochloride3Preferred Brand17%17%None
ORENCIA 125 mg/mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ORENCIA 125 mg/mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ORENCIA 50 mg/.4mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 1.6 per 28 days
ORENCIA 87.5 mg/.7mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 2.8 per 28 days
ORENITRAM .125 mg Tablet, Extended ReleaseTreprostinil4Non-Preferred Drug50%50%
  • PA
ORENITRAM .25 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 1 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 2.5 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM 5 mg Tablet, Extended ReleaseTreprostinil5Specialty Tier25%N/A
  • PA
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
  • QL 336 per 365 days
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
  • QL 672 per 365 days
ORENITRAM KitTreprostinil5Specialty Tier25%N/A
  • PA
  • QL 504 per 365 days
ORGOVYX 120 mg Tablet, Film CoatedRelugolix5Specialty Tier25%N/A
  • PA
ORKAMBI 100/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
ORKAMBI 200/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 112 per 28 days
ORPHENADRINE CITRATE 100 mg Tablet, Extended Release3Preferred Brand17%17%None
ORQUIDEA .35 mg TabletNorethindrone3Preferred Brand17%17%None
ORSERDU 345 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
ORSERDU 86 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
OSELTAMIVIR PHOSPHATE 30 mg Capsule3Preferred Brand17%17%
  • QL 168 per 365 days
OSELTAMIVIR PHOSPHATE 45 mg Capsule3Preferred Brand17%17%
  • QL 84 per 365 days
OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension3Preferred Brand17%17%
  • QL 108 per 365 days
OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir3Preferred Brand17%17%
  • QL 11 per 365 days
OSENVELT 120 mg/1.7mL InjectionDenosumab-Bmwo5Specialty Tier25%N/A
  • PA
OSPHENA 60 mg Tablet, Film CoatedOspemifene4Non-Preferred Drug50%50%
  • PA
  • QL 3 per 30 days
OTEZLA 20 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA 30 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OXAPROZIN 600 mg Tablet, Film Coated4Non-Preferred Drug50%50%None
OXCARBAZEPINE 150 mg Tablet, Film Coated3Preferred Brand17%17%None
OXCARBAZEPINE 300 mg Tablet, Film Coated3Preferred Brand17%17%None
OXCARBAZEPINE 300 mg/5mL Suspension4Non-Preferred Drug50%50%None
OXCARBAZEPINE 600 mg Tablet, Film Coated3Preferred Brand17%17%None
OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release2Generic$17.00$42.50None
OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release2Generic$17.00$42.50None
OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release2Generic$17.00$42.50None
OXYBUTYNIN CHLORIDE 5 mg Tablet2Generic$17.00$42.50None
OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup2Generic$17.00$42.50None
OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand17%17%None
OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet4Non-Preferred Drug50%50%None
OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen2Generic$17.00$42.50None
OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand17%17%None
OXYCODONE HYDROCHLORIDE 10 mg Tablet2Generic$17.00$42.50None
OXYCODONE HYDROCHLORIDE 15 mg Tablet2Generic$17.00$42.50None
OXYCODONE HYDROCHLORIDE 20 mg Tablet3Preferred Brand17%17%None
OXYCODONE HYDROCHLORIDE 30 mg Tablet3Preferred Brand17%17%None
OXYCODONE HYDROCHLORIDE 5 mg Tablet2Generic$17.00$42.50None
OXYCODONE HYDROCHLORIDE 5 mg/5mL Solution4Non-Preferred Drug50%50%None
OZEMPIC .68 mg/mL Injection, SolutionSemaglutide3Preferred Brand17%17%
  • PA
  • QL 3 per 28 days
OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide3Preferred Brand17%17%
  • PA
  • QL 3 per 28 days
OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide3Preferred Brand17%17%
  • PA
  • QL 3 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.