MedicarePartD.guide

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2026 HealthSpring Assurance Rx (PDP) formulary (drug list)

Contract S5617, plan 008 · Vermont · 3,188 drugs on file · formulary ID 00026089. Each drug links to its cost in every CMS PDP Region 02 plan.

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126 drugs starting with V.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
VALACYCLOVIR 1 g Tablet, Film Coated3Preferred Brand21%21%
  • QL 12 per 30 days
VALACYCLOVIR 500 mg Tablet, Film Coated3Preferred Brand21%21%
  • QL 6 per 30 days
VALCHLOR .012 g/60g GelMechlorethamine Hydrochloride5Specialty Tier25%N/A
  • PA
VALGANCICLOVIR 450 mg Tablet, Film Coated3Preferred Brand21%21%None
VALGANCICLOVIR HYDROCHLORIDE 50 mg/mL Powder, For Solution5Specialty Tier25%N/ANone
VALPROIC ACID 250 mg Capsule, Liquid Filled2Generic$2.00$2.00None
VALPROIC ACID 250 mg/5mL Solution2Generic$2.00$2.00None
VALSARTAN 160 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
VALSARTAN 320 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALSARTAN 40 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
VALSARTAN 80 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 6 per 30 days
VALSARTAN AND HYDROCHLOROTHIAZIDE 160/12.5 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALSARTAN AND HYDROCHLOROTHIAZIDE 160/25 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALSARTAN AND HYDROCHLOROTHIAZIDE 320/12.5 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALSARTAN AND HYDROCHLOROTHIAZIDE 320/25 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALSARTAN AND HYDROCHLOROTHIAZIDE 80/12.5 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 3 per 30 days
VALTOCO 10 mg/.1mL SprayDiazepam5Specialty Tier25%N/A
  • PA
  • QL 1 per 30 days
VALTOCO 10 mg/.1mL SprayDiazepam5Specialty Tier25%N/A
  • PA
  • QL 1 per 30 days
VALTOCO 5 mg/.1mL SprayDiazepam5Specialty Tier25%N/A
  • PA
  • QL 1 per 30 days
VALTOCO 7.5 mg/.1mL SprayDiazepam5Specialty Tier25%N/A
  • PA
  • QL 1 per 30 days
VANCOMYCIN HYDROCHLORIDE 1 g/20mL Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug31%31%None
VANCOMYCIN HYDROCHLORIDE 10 g/100mL Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug31%31%None
VANCOMYCIN HYDROCHLORIDE 125 mg Capsule4Non-Preferred Drug31%31%
  • PA
  • QL 4 per 10 days
VANCOMYCIN HYDROCHLORIDE 250 mg Capsule4Non-Preferred Drug31%31%
  • PA
  • QL 8 per 10 days
VANCOMYCIN HYDROCHLORIDE 250 mg/5mL Powder, For Solution4Non-Preferred Drug31%31%
  • QL 45 per 10 days
VANCOMYCIN HYDROCHLORIDE 500 mg Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug31%31%None
VANCOMYCIN HYDROCHLORIDE 750 mg Injection, Powder, Lyophilized, For Solution4Non-Preferred Drug31%31%None
VANCOMYCIN HYDROCHLORIDE Kit4Non-Preferred Drug31%31%
  • QL 45 per 10 days
VANDAZOLE 7.5 mg/g GelMetronidazole4Non-Preferred Drug31%31%None
VANFLYTA 17.7 mg Tablet, Film CoatedQuizartinib5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
VANFLYTA 26.5 mg Tablet, Film CoatedQuizartinib5Specialty Tier25%N/A
  • PA
  • QL 56 per 28 days
VAQTA 25 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine, Inactivated3Preferred Brand21%21%None
VAQTA 25 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine, Inactivated3Preferred Brand21%21%None
VAQTA 50 [iU]/mL Injection, SuspensionHepatitis A Vaccine, Inactivated3Preferred Brand21%21%None
VAQTA 50 [iU]/mL Injection, SuspensionHepatitis A Vaccine, Inactivated3Preferred Brand21%21%None
VARENICLINE .5 mg Tablet, Film CoatedVarenicline Tartrate4Non-Preferred Drug31%31%None
VARENICLINE 1 mg Tablet, Film CoatedVarenicline Tartrate4Non-Preferred Drug31%31%None
VARENICLINE KitVarenicline Tartrate4Non-Preferred Drug31%31%None
VARENICLINE TARTRATE 1 mg Tablet, Film Coated4Non-Preferred Drug31%31%None
VARIVAX 1350 [PFU]/.5mL Injection, Powder, Lyophilized, For SuspensionVaricella Virus Vaccine Live3Preferred Brand21%21%None
VAXCHORA KitCholera Vaccine, Live, Oral3Preferred Brand21%21%None
VELIVET TRIPHASIC REGIMEN KitDesogestrel And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VELTASSA 1 g Powder, For SuspensionPatiromer4Non-Preferred Drug31%31%
  • QL 12 per 30 days
VELTASSA 16.8 g Powder, For SuspensionPatiromer4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VELTASSA 25.2 g Powder, For SuspensionPatiromer4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VELTASSA 8.4 g Powder, For SuspensionPatiromer4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VEMLIDY 25 mg TabletTenofovir Alafenamide5Specialty Tier25%N/ANone
VENCLEXTA 10 mg Tablet, Film CoatedVenetoclax4Non-Preferred Drug31%31%
  • PA
  • QL 6 per 30 days
VENCLEXTA 100 mg Tablet, Film CoatedVenetoclax5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
VENCLEXTA 50 mg Tablet, Film CoatedVenetoclax5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VENCLEXTA KitVenetoclax5Specialty Tier25%N/A
  • PA
  • QL 84 per 365 days
VENLAFAXINE HYDROCHLORIDE 100 mg Tablet2Generic$2.00$2.00
  • QL 9 per 30 days
VENLAFAXINE HYDROCHLORIDE 150 mg Capsule, Extended Release2Generic$2.00$2.00
  • QL 6 per 30 days
VENLAFAXINE HYDROCHLORIDE 25 mg Tablet2Generic$2.00$2.00
  • QL 9 per 30 days
VENLAFAXINE HYDROCHLORIDE 37.5 mg Capsule, Extended Release2Generic$2.00$2.00
  • QL 6 per 30 days
VENLAFAXINE HYDROCHLORIDE 37.5 mg Tablet2Generic$2.00$2.00
  • QL 9 per 30 days
VENLAFAXINE HYDROCHLORIDE 50 mg Tablet2Generic$2.00$2.00
  • QL 12 per 30 days
VENLAFAXINE HYDROCHLORIDE 75 mg Capsule, Extended Release2Generic$2.00$2.00
  • QL 9 per 30 days
VENLAFAXINE HYDROCHLORIDE 75 mg Tablet2Generic$2.00$2.00
  • QL 12 per 30 days
VENTOLIN HFA 90 ug Aerosol, MeteredAlbuterol Sulfate3Preferred Brand21%21%
  • QL 36 per 30 days
VERAPAMIL HYDROCHLORIDE 100 mg Capsule, Extended Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 120 mg Capsule, Extended Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 120 mg Tablet2Generic$2.00$2.00None
VERAPAMIL HYDROCHLORIDE 120 mg Tablet, Film Coated, Extended Release2Generic$2.00$2.00None
VERAPAMIL HYDROCHLORIDE 180 mg Capsule, Extended Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 180 mg Tablet, Film Coated, Extended Release2Generic$2.00$2.00None
VERAPAMIL HYDROCHLORIDE 200 mg Capsule, Extended Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 240 mg Capsule, Delayed Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 240 mg Tablet, Film Coated, Extended Release2Generic$2.00$2.00None
VERAPAMIL HYDROCHLORIDE 300 mg Capsule, Extended Release3Preferred Brand21%21%None
VERAPAMIL HYDROCHLORIDE 360 mg Capsule, Delayed Release4Non-Preferred Drug31%31%None
VERAPAMIL HYDROCHLORIDE 40 mg Tablet2Generic$2.00$2.00None
VERAPAMIL HYDROCHLORIDE 80 mg Tablet2Generic$2.00$2.00None
VERQUVO 10 mg Tablet, Film CoatedVericiguat3Preferred Brand21%21%
  • PA
  • QL 3 per 30 days
VERQUVO 2.5 mg Tablet, Film CoatedVericiguat3Preferred Brand21%21%
  • PA
  • QL 3 per 30 days
VERQUVO 5 mg Tablet, Film CoatedVericiguat3Preferred Brand21%21%
  • PA
  • QL 3 per 30 days
VERSACLOZ 50 mg/mL SuspensionClozapine5Specialty Tier25%N/ANone
VERZENIO 100 mg TabletAbemaciclib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VERZENIO 150 mg TabletAbemaciclib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VERZENIO 200 mg TabletAbemaciclib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VERZENIO 50 mg TabletAbemaciclib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VESTURA KitDrospirenone And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VIENVA KitLevonorgestrel And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VIGABATRIN 500 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
VIGABATRIN 500 mg/mL Powder, For Solution5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
VIGADRONE 50 mg/mL Powder, For SolutionVigabatrin5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
VIGADRONE 500 mg TabletVigabatrin5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
VIGAFYDE 100 mg/mL SolutionVigabatrin5Specialty Tier25%N/A
  • PA
  • QL 9 per 30 days
VILAZODONE HYDROCHLORIDE 10 mg Tablet4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VILAZODONE HYDROCHLORIDE 20 mg Tablet4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VILAZODONE HYDROCHLORIDE 40 mg Tablet4Non-Preferred Drug31%31%
  • QL 3 per 30 days
VIMKUNYA 10/15/15 ug/.8mL Injection, SuspensionChikungunya Vaccine, Recombinant3Preferred Brand21%21%
  • QL 1 per 999 days
VIORELE KitDesogestrel And Ethinyl Estradiol And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VIRACEPT 250 mg Tablet, Film CoatedNelfinavir Mesylate4Non-Preferred Drug31%31%
  • QL 27 per 30 days
VIRACEPT 625 mg Tablet, Film CoatedNelfinavir Mesylate4Non-Preferred Drug31%31%
  • QL 12 per 30 days
VIREAD 150 mg Tablet, CoatedTenofovir Disoproxil Fumarate5Specialty Tier25%N/A
  • QL 3 per 30 days
VIREAD 200 mg Tablet, CoatedTenofovir Disoproxil Fumarate5Specialty Tier25%N/A
  • QL 3 per 30 days
VIREAD 250 mg Tablet, CoatedTenofovir Disoproxil Fumarate5Specialty Tier25%N/A
  • QL 3 per 30 days
VIREAD 40 mg/g PowderTenofovir Disoproxil Fumarate5Specialty Tier25%N/A
  • QL 24 per 30 days
VITRAKVI 100 mg CapsuleLarotrectinib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VITRAKVI 20 mg/mL Solution, ConcentrateLarotrectinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VITRAKVI 25 mg CapsuleLarotrectinib5Specialty Tier25%N/A
  • PA
  • QL 18 per 30 days
VIVITROL KitNaltrexone5Specialty Tier25%N/ANone
VIVOTIF 6000000000 [CFU] Capsule, CoatedSalmonella Typhi Ty21A3Preferred Brand21%21%
  • QL 4 per 720 days
VIZIMPRO 15 mg Tablet, Film CoatedDacomitinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VIZIMPRO 30 mg Tablet, Film CoatedDacomitinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VIZIMPRO 45 mg Tablet, Film CoatedDacomitinib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VONJO 100 mg CapsulePacritinib5Specialty Tier25%N/A
  • PA
  • QL 12 per 30 days
VORANIGO 10 mg Tablet, Film CoatedVorasidenib5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
VORANIGO 40 mg Tablet, Film CoatedVorasidenib5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
VORICONAZOLE 10 mg/mL Injection, Powder, Lyophilized, For Solution5Specialty Tier25%N/A
  • PA
VORICONAZOLE 200 mg Tablet, Film Coated4Non-Preferred Drug31%31%None
VORICONAZOLE 40 mg/mL Powder, For Suspension5Specialty Tier25%N/ANone
VORICONAZOLE 50 mg Tablet, Film Coated4Non-Preferred Drug31%31%None
VOSEVI 400/100/100 mg Tablet, Film CoatedSofosbuvir, Velpatasvir, And Voxilaprevir5Specialty Tier25%N/A
  • PA
  • QL 28 per 28 days
VOWST 30000000 [CFU] CapsuleFecal Microbiota Spores, Live-Brpk5Specialty Tier25%N/A
  • PA
VRAYLAR .5 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VRAYLAR .75 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VRAYLAR 1.5 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VRAYLAR 3 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VRAYLAR 4.5 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VRAYLAR 6 mg Capsule, Gelatin CoatedCariprazine5Specialty Tier25%N/A
  • QL 3 per 30 days
VYFEMLA KitNorethindrone And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VYLIBRA KitNorgestimate And Ethinyl Estradiol4Non-Preferred Drug31%31%None
VYNDAMAX 61 mg Capsule, Liquid FilledTafamidis5Specialty Tier25%N/A
  • PA
VYVGART HYTRULO 200/2000 mg/mL/U/mL Injection, SolutionEfgartigimod Alfa And Hyaluronidase (Human Recombinant)4Non-Preferred Drug31%31%
  • 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.