2026 Humana Premier Rx Plan (PDP) formulary (drug list)
Contract S5884, plan 162 · Wisconsin · 3,076 drugs on file · formulary ID 00026402. Each drug links to its cost in every CMS PDP Region 16 plan.
119 drugs starting with V.
| Drug name | Tier | 30-day preferred pharmacy | 90-day mail order | Usage management |
|---|---|---|---|---|
| VALACYCLOVIR 1 g Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| VALACYCLOVIR 500 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 | None |
| VALCHLOR .012 g/60g GelMechlorethamine Hydrochloride | 5Specialty Tier | 33% | N/A |
|
| VALGANCICLOVIR 450 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 |
|
| VALGANCICLOVIR HYDROCHLORIDE 50 mg/mL Powder, For Solution | 5Specialty Tier | 33% | N/A |
|
| VALPROIC ACID 250 mg Capsule, Liquid Filled | 2Generic | $4.00 | $0.00 | None |
| VALPROIC ACID 250 mg/5mL Solution | 2Generic | $4.00 | $0.00 | None |
| VALSARTAN 160 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN 320 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN 40 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN 80 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN AND HYDROCHLOROTHIAZIDE 160/12.5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN AND HYDROCHLOROTHIAZIDE 160/25 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN AND HYDROCHLOROTHIAZIDE 320/12.5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN AND HYDROCHLOROTHIAZIDE 320/25 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALSARTAN AND HYDROCHLOROTHIAZIDE 80/12.5 mg Tablet, Film Coated | 1Preferred Generic | $0.00 | $0.00 |
|
| VALTOCO 10 mg/.1mL SprayDiazepam | 5Specialty Tier | 33% | N/A |
|
| VALTOCO 10 mg/.1mL SprayDiazepam | 5Specialty Tier | 33% | N/A |
|
| VALTOCO 5 mg/.1mL SprayDiazepam | 5Specialty Tier | 33% | N/A |
|
| VALTOCO 7.5 mg/.1mL SprayDiazepam | 5Specialty Tier | 33% | N/A |
|
| VANCOMYCIN HYDROCHLORIDE 1 g/20mL Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| VANCOMYCIN HYDROCHLORIDE 10 g/100mL Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| VANCOMYCIN HYDROCHLORIDE 125 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| VANCOMYCIN HYDROCHLORIDE 250 mg Capsule | 4Non-Preferred Drug | 50% | 50% |
|
| VANCOMYCIN HYDROCHLORIDE 500 mg Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| VANCOMYCIN HYDROCHLORIDE 750 mg Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| VANFLYTA 17.7 mg Tablet, Film CoatedQuizartinib | 5Specialty Tier | 33% | N/A |
|
| VANFLYTA 26.5 mg Tablet, Film CoatedQuizartinib | 5Specialty Tier | 33% | N/A |
|
| VAQTA 25 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine, Inactivated | 1Preferred Generic | $0.00 | $0.00 | None |
| VAQTA 25 [iU]/.5mL Injection, SuspensionHepatitis A Vaccine, Inactivated | 1Preferred Generic | $0.00 | $0.00 | None |
| VAQTA 50 [iU]/mL Injection, SuspensionHepatitis A Vaccine, Inactivated | 1Preferred Generic | $0.00 | $0.00 | None |
| VAQTA 50 [iU]/mL Injection, SuspensionHepatitis A Vaccine, Inactivated | 1Preferred Generic | $0.00 | $0.00 | None |
| VARENICLINE .5 mg Tablet, Film CoatedVarenicline Tartrate | 3Preferred Brand | $45.00 | $125.00 |
|
| VARENICLINE 1 mg Tablet, Film CoatedVarenicline Tartrate | 3Preferred Brand | $45.00 | $125.00 |
|
| VARENICLINE KitVarenicline Tartrate | 3Preferred Brand | $45.00 | $125.00 |
|
| VARENICLINE TARTRATE 1 mg Tablet, Film Coated | 3Preferred Brand | $45.00 | $125.00 |
|
| VARIVAX 1350 [PFU]/.5mL Injection, Powder, Lyophilized, For SuspensionVaricella Virus Vaccine Live | 1Preferred Generic | $0.00 | $0.00 | None |
| VASCEPA 1000 mg CapsuleIcosapent Ethyl | 3Preferred Brand | $45.00 | $125.00 |
|
| VASCEPA 500 mg CapsuleIcosapent Ethyl | 3Preferred Brand | $45.00 | $125.00 |
|
| VAXCHORA KitCholera Vaccine, Live, Oral | 1Preferred Generic | $0.00 | $0.00 | None |
| VELIVET TRIPHASIC REGIMEN KitDesogestrel And Ethinyl Estradiol | 2Generic | $4.00 | $0.00 | None |
| VENCLEXTA 10 mg Tablet, Film CoatedVenetoclax | 3Preferred Brand | $45.00 | $125.00 |
|
| VENCLEXTA 100 mg Tablet, Film CoatedVenetoclax | 5Specialty Tier | 33% | N/A |
|
| VENCLEXTA 50 mg Tablet, Film CoatedVenetoclax | 5Specialty Tier | 33% | N/A |
|
| VENCLEXTA KitVenetoclax | 5Specialty Tier | 33% | N/A |
|
| VENLAFAXINE HYDROCHLORIDE 100 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| VENLAFAXINE HYDROCHLORIDE 150 mg Capsule, Extended Release | 2Generic | $4.00 | $0.00 |
|
| VENLAFAXINE HYDROCHLORIDE 25 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| VENLAFAXINE HYDROCHLORIDE 37.5 mg Capsule, Extended Release | 2Generic | $4.00 | $0.00 |
|
| VENLAFAXINE HYDROCHLORIDE 37.5 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| VENLAFAXINE HYDROCHLORIDE 50 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| VENLAFAXINE HYDROCHLORIDE 75 mg Capsule, Extended Release | 2Generic | $4.00 | $0.00 |
|
| VENLAFAXINE HYDROCHLORIDE 75 mg Tablet | 2Generic | $4.00 | $0.00 | None |
| VENTOLIN HFA 90 ug Aerosol, MeteredAlbuterol Sulfate | 3Preferred Brand | $45.00 | $125.00 |
|
| VERAPAMIL HYDROCHLORIDE 100 mg Capsule, Extended Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 120 mg Capsule, Extended Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 120 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| VERAPAMIL HYDROCHLORIDE 120 mg Tablet, Film Coated, Extended Release | 2Generic | $4.00 | $0.00 | None |
| VERAPAMIL HYDROCHLORIDE 180 mg Capsule, Extended Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 180 mg Tablet, Film Coated, Extended Release | 2Generic | $4.00 | $0.00 | None |
| VERAPAMIL HYDROCHLORIDE 200 mg Capsule, Extended Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 240 mg Capsule, Delayed Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 240 mg Tablet, Film Coated, Extended Release | 2Generic | $4.00 | $0.00 | None |
| VERAPAMIL HYDROCHLORIDE 300 mg Capsule, Extended Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 360 mg Capsule, Delayed Release | 3Preferred Brand | $45.00 | $125.00 | None |
| VERAPAMIL HYDROCHLORIDE 40 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| VERAPAMIL HYDROCHLORIDE 80 mg Tablet | 1Preferred Generic | $0.00 | $0.00 | None |
| VERQUVO 10 mg Tablet, Film CoatedVericiguat | 3Preferred Brand | $45.00 | $125.00 |
|
| VERQUVO 2.5 mg Tablet, Film CoatedVericiguat | 3Preferred Brand | $45.00 | $125.00 |
|
| VERQUVO 5 mg Tablet, Film CoatedVericiguat | 3Preferred Brand | $45.00 | $125.00 |
|
| VERSACLOZ 50 mg/mL SuspensionClozapine | 4Non-Preferred Drug | 50% | 50% |
|
| VERZENIO 100 mg TabletAbemaciclib | 5Specialty Tier | 33% | N/A |
|
| VERZENIO 150 mg TabletAbemaciclib | 5Specialty Tier | 33% | N/A |
|
| VERZENIO 200 mg TabletAbemaciclib | 5Specialty Tier | 33% | N/A |
|
| VERZENIO 50 mg TabletAbemaciclib | 5Specialty Tier | 33% | N/A |
|
| VESTURA KitDrospirenone And Ethinyl Estradiol | 2Generic | $4.00 | $0.00 | None |
| VIENVA KitLevonorgestrel And Ethinyl Estradiol | 2Generic | $4.00 | $0.00 | None |
| VIGABATRIN 500 mg Tablet, Film Coated | 5Specialty Tier | 33% | N/A |
|
| VIGABATRIN 500 mg/mL Powder, For Solution | 5Specialty Tier | 33% | N/A |
|
| VIGADRONE 50 mg/mL Powder, For SolutionVigabatrin | 5Specialty Tier | 33% | N/A |
|
| VIGADRONE 500 mg TabletVigabatrin | 5Specialty Tier | 33% | N/A |
|
| VIGAFYDE 100 mg/mL SolutionVigabatrin | 5Specialty Tier | 33% | N/A |
|
| VILAZODONE HYDROCHLORIDE 10 mg Tablet | 4Non-Preferred Drug | 50% | 50% |
|
| VILAZODONE HYDROCHLORIDE 20 mg Tablet | 4Non-Preferred Drug | 50% | 50% |
|
| VILAZODONE HYDROCHLORIDE 40 mg Tablet | 4Non-Preferred Drug | 50% | 50% |
|
| VIMKUNYA 10/15/15 ug/.8mL Injection, SuspensionChikungunya Vaccine, Recombinant | 1Preferred Generic | $0.00 | $0.00 | None |
| VIORELE KitDesogestrel And Ethinyl Estradiol And Ethinyl Estradiol | 2Generic | $4.00 | $0.00 | None |
| VIRACEPT 250 mg Tablet, Film CoatedNelfinavir Mesylate | 5Specialty Tier | 33% | N/A |
|
| VIRACEPT 625 mg Tablet, Film CoatedNelfinavir Mesylate | 5Specialty Tier | 33% | N/A |
|
| VIREAD 150 mg Tablet, CoatedTenofovir Disoproxil Fumarate | 5Specialty Tier | 33% | N/A |
|
| VIREAD 200 mg Tablet, CoatedTenofovir Disoproxil Fumarate | 5Specialty Tier | 33% | N/A |
|
| VIREAD 250 mg Tablet, CoatedTenofovir Disoproxil Fumarate | 5Specialty Tier | 33% | N/A |
|
| VIREAD 40 mg/g PowderTenofovir Disoproxil Fumarate | 5Specialty Tier | 33% | N/A |
|
| VITRAKVI 100 mg CapsuleLarotrectinib | 5Specialty Tier | 33% | N/A |
|
| VITRAKVI 20 mg/mL Solution, ConcentrateLarotrectinib | 5Specialty Tier | 33% | N/A |
|
| VITRAKVI 25 mg CapsuleLarotrectinib | 5Specialty Tier | 33% | N/A |
|
| VIVITROL KitNaltrexone | 5Specialty Tier | 33% | N/A |
|
| VIVOTIF 6000000000 [CFU] Capsule, CoatedSalmonella Typhi Ty21A | 1Preferred Generic | $0.00 | $0.00 | None |
| VIZIMPRO 15 mg Tablet, Film CoatedDacomitinib | 5Specialty Tier | 33% | N/A |
|
| VIZIMPRO 30 mg Tablet, Film CoatedDacomitinib | 5Specialty Tier | 33% | N/A |
|
| VIZIMPRO 45 mg Tablet, Film CoatedDacomitinib | 5Specialty Tier | 33% | N/A |
|
| VONJO 100 mg CapsulePacritinib | 5Specialty Tier | 33% | N/A |
|
| VORANIGO 10 mg Tablet, Film CoatedVorasidenib | 5Specialty Tier | 33% | N/A |
|
| VORANIGO 40 mg Tablet, Film CoatedVorasidenib | 5Specialty Tier | 33% | N/A |
|
| VORICONAZOLE 10 mg/mL Injection, Powder, Lyophilized, For Solution | 4Non-Preferred Drug | 50% | 50% | None |
| VORICONAZOLE 200 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| VORICONAZOLE 40 mg/mL Powder, For Suspension | 5Specialty Tier | 33% | N/A |
|
| VORICONAZOLE 50 mg Tablet, Film Coated | 4Non-Preferred Drug | 50% | 50% |
|
| VOSEVI 400/100/100 mg Tablet, Film CoatedSofosbuvir, Velpatasvir, And Voxilaprevir | 5Specialty Tier | 33% | N/A |
|
| VOWST 30000000 [CFU] CapsuleFecal Microbiota Spores, Live-Brpk | 5Specialty Tier | 33% | N/A |
|
| VRAYLAR .5 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VRAYLAR .75 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VRAYLAR 1.5 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VRAYLAR 3 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VRAYLAR 4.5 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VRAYLAR 6 mg Capsule, Gelatin CoatedCariprazine | 4Non-Preferred Drug | 50% | 50% |
|
| VYFEMLA KitNorethindrone And Ethinyl Estradiol | 4Non-Preferred Drug | 50% | 50% | None |
| VYLIBRA KitNorgestimate And Ethinyl Estradiol | 2Generic | $4.00 | $0.00 | None |
| VYZULTA .24 mg/mL Solution/ DropsLatanoprostene Bunod | 4Non-Preferred Drug | 50% | 50% |
|
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.