MedicarePartD.guide

A non-government resource built from CMS public data

2026 MedicareBlue Rx Standard (PDP) formulary (drug list)

Contract S5743, plan 001 · South Dakota · 2,948 drugs on file · formulary ID 00026248. Each drug links to its cost in every CMS PDP Region 25 plan.

Hide drugs on tiers

51 drugs starting with X.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
XALKORI 150 mg Capsule, Coated PelletsCrizotinib5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
XALKORI 20 mg Capsule, Coated PelletsCrizotinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XALKORI 200 mg CapsuleCrizotinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XALKORI 250 mg CapsuleCrizotinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XALKORI 50 mg Capsule, Coated PelletsCrizotinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XARAH FE KitNorethindrone Acetate And Ethinyl Estradiol And Ferrous Fumarate Tablets4Non-Preferred Drug42%42%None
XARELTO 10 mg Tablet, Film CoatedRivaroxaban3Preferred Brand22%22%
  • QL 3 per 30 days
XARELTO 15 mg Tablet, Film CoatedRivaroxaban3Preferred Brand22%22%
  • QL 6 per 30 days
XARELTO 2.5 mg Tablet, Film CoatedRivaroxaban3Preferred Brand22%22%
  • QL 6 per 30 days
XARELTO 20 mg Tablet, Film CoatedRivaroxaban3Preferred Brand22%22%
  • QL 3 per 30 days
XARELTO KitRivaroxaban3Preferred Brand22%22%
  • QL 51 per 30 days
XATMEP 2.5 mg/mL SolutionMethotrexate4Non-Preferred Drug42%42%
  • PA
XCOPRI 100 mg Tablet, Film CoatedCenobamate5Specialty Tier25%N/ANone
XCOPRI 150 mg Tablet, Film CoatedCenobamate5Specialty Tier25%N/ANone
XCOPRI 200 mg Tablet, Film CoatedCenobamate5Specialty Tier25%N/ANone
XCOPRI 25 mg Tablet, Film CoatedCenobamate5Specialty Tier25%N/ANone
XCOPRI 50 mg Tablet, Film CoatedCenobamate5Specialty Tier25%N/ANone
XCOPRI MAINTENANCE PACK KitCenobamate5Specialty Tier25%N/ANone
XCOPRI MAINTENANCE PACK KitCenobamate5Specialty Tier25%N/ANone
XCOPRI TITRATION PACK KitCenobamate4Non-Preferred Drug42%42%None
XCOPRI TITRATION PACK KitCenobamate5Specialty Tier25%N/ANone
XCOPRI TITRATION PACK KitCenobamate5Specialty Tier25%N/ANone
XDEMVY 2.5 mg/mL Solution/ DropsLotilaner Ophthalmic Solution5Specialty Tier25%N/A
  • PA
XERMELO 250 mg TabletTelotristat Ethyl5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
XIFAXAN 550 mg TabletRifaximin5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
XIGDUO XR 10/1000 mg Tablet, Film Coated, Extended ReleaseDapagliflozin And Metformin Hydrochloride3Preferred Brand22%22%
  • QL 3 per 30 days
XIGDUO XR 10/500 mg Tablet, Film Coated, Extended ReleaseDapagliflozin And Metformin Hydrochloride3Preferred Brand22%22%
  • QL 3 per 30 days
XIGDUO XR 2.5/1000 mg Tablet, Film Coated, Extended ReleaseDapagliflozin And Metformin Hydrochloride3Preferred Brand22%22%
  • QL 6 per 30 days
XIGDUO XR 5/1000 mg Tablet, Film Coated, Extended ReleaseDapagliflozin And Metformin Hydrochloride3Preferred Brand22%22%
  • QL 6 per 30 days
XIGDUO XR 5/500 mg Tablet, Film Coated, Extended ReleaseDapagliflozin And Metformin Hydrochloride3Preferred Brand22%22%
  • QL 3 per 30 days
XIIDRA 50 mg/mL Solution/ DropsLifitegrast3Preferred Brand22%22%
  • PA
  • QL 6 per 30 days
XOFLUZA 40 mg Tablet, Film CoatedBaloxavir Marboxil4Non-Preferred Drug42%42%
  • QL 4 per 365 days
XOFLUZA 80 mg Tablet, Film CoatedBaloxavir Marboxil4Non-Preferred Drug42%42%
  • QL 2 per 365 days
XOLAIR 150 mg/1.2mL Injection, SolutionOmalizumab5Specialty Tier25%N/A
  • PA
XOLAIR 300 mg/2mL Injection, SolutionOmalizumab5Specialty Tier25%N/A
  • PA
XOLAIR 300 mg/2mL Injection, SolutionOmalizumab5Specialty Tier25%N/A
  • PA
XOLAIR PFS 150 mg/mL Injection, SolutionOmalizumab5Specialty Tier25%N/A
  • PA
XOLAIR PFS 75 mg/.5mL Injection, SolutionOmalizumab5Specialty Tier25%N/A
  • PA
XOSPATA 40 mg TabletGilteritinib5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
XPOVIO 10 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 16 per 28 days
XPOVIO 20 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 24 per 28 days
XPOVIO 20 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 32 per 28 days
XPOVIO 40 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
XPOVIO 40 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
XPOVIO 50 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
XPOVIO 60 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
XPOVIO 80 mg Tablet, Film CoatedSelinexor5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
XTANDI 40 mg CapsuleEnzalutamide5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XTANDI 40 mg TabletEnzalutamide5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
XTANDI 80 mg TabletEnzalutamide5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
XULANE 150/35 ug/d PatchNorelgestromin And Ethinyl Estradiol3Preferred Brand22%22%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.