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.
11 drugs starting with U.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| UBRELVY 100 mg TabletUbrogepant | 5Specialty Tier | 25% | N/A |
|
| UBRELVY 50 mg TabletUbrogepant | 5Specialty Tier | 25% | N/A |
|
| UDENYCA 6 mg/.6mL Injection, SolutionPegfilgrastim-Cbqv | 5Specialty Tier | 25% | N/A |
|
| UDENYCA 6 mg/.6mL Injection, SolutionPegfilgrastim-Cbqv | 5Specialty Tier | 25% | N/A |
|
| ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets | 4Non-Preferred Drug | 50% | 50% | None |
| ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets | 4Non-Preferred Drug | 50% | 50% | None |
| URSODIOL 250 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| URSODIOL 500 mg Tablet | 3Preferred Brand | 17% | 17% | None |
| USTEKINUMAB 45 mg/.5mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
| USTEKINUMAB 45 mg/.5mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
| USTEKINUMAB 90 mg/mL Injection, Solution | 5Specialty Tier | 25% | N/A |
|
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.