MedicarePartD.guide

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2026 Wellcare Classic (PDP) formulary (drug list)

Contract S4802, plan 097 · Wisconsin · 2,922 drugs on file · formulary ID 00026191. Each drug links to its cost in every CMS PDP Region 16 plan.

Hide drugs on tiers

19 drugs starting with U.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug26%26%None
ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug26%26%None
UPTRAVI 1000 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1200 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1400 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 1600 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 200 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 400 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 600 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI 800 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 6 per 30 days
UPTRAVI TITRATION PACK KitSelexipag5Specialty Tier25%N/A
  • PA
  • QL 2 per 180 days
URSODIOL 250 mg Tablet4Non-Preferred Drug26%26%None
URSODIOL 300 mg Capsule3Preferred Brand25%25%None
URSODIOL 500 mg Tablet4Non-Preferred Drug26%26%None
USTEKINUMAB 45 mg/.5mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 0.5 per 28 days
USTEKINUMAB-AEKN 45 mg/.5mL Injection, Solution3Preferred Brand25%25%
  • PA
  • QL 0.5 per 28 days
USTEKINUMAB-AEKN 90 mg/mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 1 per 28 days
USTEKINUMAB-TTWE 45 mg/.5mL Injection, Solution3Preferred Brand25%25%
  • PA
  • QL 0.5 per 28 days
USTEKINUMAB-TTWE 90 mg/mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 1 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.