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2026 Blue Rx PDP Complete (PDP) formulary (drug list)

Contract S5593, plan 003 · West Virginia · 3,788 drugs on file · formulary ID 00026017. Each drug links to its cost in every CMS PDP Region 06 plan.

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180 drugs starting with E.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
ECONAZOLE NITRATE 10 mg/g Cream2Generic$5.00$12.50
  • QL 85 per 28 days
EDARBYCLOR 40/12.5 mg TabletAzilsartan Kamedoxomil And Chlorthalidone4Non-Preferred Drug25%25%None
EDARBYCLOR 40/25 mg TabletAzilsartan Kamedoxomil And Chlorthalidone4Non-Preferred Drug25%25%None
EDURANT 25 mg Tablet, Film CoatedRilpivirine Hydrochloride5Specialty Tier25%N/ANone
EDURANT PED 2.5 mg Tablet, For SuspensionRilpivirine Hydrochloride5Specialty Tier25%N/ANone
EFAVIRENZ 600 mg Tablet, Film Coated3Preferred Brand25%25%None
EFAVIRENZ, EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 600/200/300 mg Tablet, Film Coated5Specialty Tier25%N/ANone
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 400/300/300 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 31 per 31 days
EFAVIRENZ, LAMIVUDINE AND TENOFOVIR DISOPROXIL FUMARATE 600/300/300 mg Tablet, Film Coated5Specialty Tier25%N/A
  • QL 31 per 31 days
ELETRIPTAN HYDROBROMIDE 20 mg Tablet, Film Coated4Non-Preferred Drug25%25%
  • QL 12 per 28 days
ELETRIPTAN HYDROBROMIDE 40 mg Tablet, Film Coated4Non-Preferred Drug25%25%
  • QL 6 per 28 days
ELIGARD 45 mg/.375mL Injection, Suspension, Extended ReleaseLeuprolide Acetate4Non-Preferred Drug25%25%
  • ST
  • QL 1 per 180 days
ELIGARD KitLeuprolide Acetate4Non-Preferred Drug25%25%
  • ST
  • QL 1 per 90 days
ELIGARD KitLeuprolide Acetate4Non-Preferred Drug25%25%
  • ST
  • QL 1 per 120 days
ELIGARD KitLeuprolide Acetate4Non-Preferred Drug25%25%
  • ST
  • QL 1 per 30 days
ELIQUIS 2.5 mg Tablet, Film CoatedApixaban3Preferred Brand25%25%
  • QL 6 per 30 days
ELIQUIS 30-DAY STARTER PACK KitApixaban3Preferred Brand25%25%
  • QL 74 per 30 days
ELIQUIS 5 mg Tablet, Film CoatedApixaban3Preferred Brand25%25%
  • QL 74 per 30 days
ELMIRON 100 mg Capsule, Gelatin CoatedPentosan Polysulfate Sodium4Non-Preferred Drug25%25%None
ELTROMBOPAG 12.5 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier25%N/A
  • PA
  • QL 372 per 31 days
ELTROMBOPAG 12.5 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ELTROMBOPAG 25 mg Powder, For SuspensionEltrombopag Olamine5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ELTROMBOPAG 25 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ELTROMBOPAG 50 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ELTROMBOPAG 75 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ELURYNG .12/.015 mg/d RingEtonogestrel And Ethinyl Estradiol3Preferred Brand25%25%None
EMEND 125 mg Powder, For SuspensionAprepitant4Non-Preferred Drug25%25%
  • PA
EMGALITY 100 mg/mL Injection, SolutionGalcanezumab-Gnlm5Specialty Tier25%N/A
  • PA
  • QL 3 per 28 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand25%25%
  • PA
  • QL 1 per 28 days
EMGALITY 120 mg/mL Injection, SolutionGalcanezumab-Gnlm3Preferred Brand25%25%
  • PA
  • QL 1 per 28 days
EMSAM 12 mg/24h PatchSelegiline5Specialty Tier25%N/A
  • QL 3 per 30 days
EMSAM 6 mg/24h PatchSelegiline5Specialty Tier25%N/A
  • QL 3 per 30 days
EMSAM 9 mg/24h PatchSelegiline5Specialty Tier25%N/A
  • QL 3 per 30 days
EMTRICITABINE 200 mg Capsule4Non-Preferred Drug25%25%None
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 100/150 mg Tablet, Film Coated4Non-Preferred Drug25%25%None
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 133/200 mg Tablet, Film Coated5Specialty Tier25%N/ANone
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 167/250 mg Tablet, Film Coated4Non-Preferred Drug25%25%None
EMTRICITABINE AND TENOFOVIR DISOPROXIL FUMARATE 200/300 mg Tablet, Film Coated4Non-Preferred Drug25%25%None
EMTRICITABINE, RILPIVIRINE, TENOFOVIR DISOPROXIL FUMARATE 200/25/300 mg Tablet, Film Coated5Specialty Tier25%N/ANone
EMTRIVA 10 mg/mL SolutionEmtricitabine3Preferred Brand25%25%None
ENALAPRIL MALEATE 10 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE 2.5 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE 20 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE 5 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 10/25 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE AND HYDROCHLOROTHIAZIDE 5/12.5 mg Tablet1Preferred Generic$0.00$0.00None
ENALAPRIL MALEATE ORAL SOLUTION 1 mg/mL SolutionEnalapril Maleate4Non-Preferred Drug25%25%None
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ENBREL 25 mg/.5mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENBREL 50 mg/mL SolutionEtanercept5Specialty Tier25%N/A
  • PA
  • QL 8 per 28 days
ENGERIX-B 10 ug/.5mL Injection, SuspensionHepatitis B Vaccine (Recombinant)3Preferred Brand25%25%
  • PA
ENGERIX-B 20 ug/mL Injection, SuspensionHepatitis B Vaccine (Recombinant)3Preferred Brand25%25%
  • PA
ENOXAPARIN SODIUM 100 mg/mL Injection2Generic$5.00$12.50None
ENOXAPARIN SODIUM 100 mg/mL Injection2Generic$5.00$12.50None
ENOXAPARIN SODIUM 100 mg/mL Injection2Generic$5.00$12.50None
ENOXAPARIN SODIUM 100 mg/mL Injection4Non-Preferred Drug25%25%None
ENOXAPARIN SODIUM 100 mg/mL Injection2Generic$5.00$12.50None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug25%25%None
ENOXAPARIN SODIUM 150 mg/mL Injection4Non-Preferred Drug25%25%None
ENSACOVE 100 mg CapsuleEnsartinib5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ENSACOVE 25 mg CapsuleEnsartinib5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ENSKYCE KitDesogestrel And Ethinyl Estradiol2Generic$5.00$12.50None
ENTACAPONE 200 mg Tablet2Generic$5.00$12.50None
ENTECAVIR .5 mg Tablet4Non-Preferred Drug25%25%None
ENTECAVIR 1 mg Tablet4Non-Preferred Drug25%25%None
ENTRESTO 15/16 mg PelletSacubitril And Valsartan3Preferred Brand25%25%
  • PA
  • QL 248 per 31 days
ENTRESTO 24/26 mg Tablet, Film CoatedSacubitril And Valsartan4Non-Preferred Drug25%25%
  • ST
  • QL 186 per 31 days
ENTRESTO 49/51 mg Tablet, Film CoatedSacubitril And Valsartan4Non-Preferred Drug25%25%
  • ST
  • QL 93 per 31 days
ENTRESTO 6/6 mg PelletSacubitril And Valsartan3Preferred Brand25%25%
  • PA
  • QL 248 per 31 days
ENTRESTO 97/103 mg Tablet, Film CoatedSacubitril And Valsartan4Non-Preferred Drug25%25%
  • ST
  • QL 62 per 31 days
ENULOSE 10 g/15mL SolutionLactulose2Generic$5.00$12.50None
ENVARSUS XR .75 mg Tablet, Extended ReleaseTacrolimus4Non-Preferred Drug25%25%
  • PA
ENVARSUS XR 1 mg Tablet, Extended ReleaseTacrolimus4Non-Preferred Drug25%25%
  • PA
ENVARSUS XR 4 mg Tablet, Extended ReleaseTacrolimus5Specialty Tier25%N/A
  • PA
EOHILIA 2 mg/10mL SuspensionBudesonide5Specialty Tier25%N/A
  • PA
  • QL 18 per 365 days
EPIDIOLEX 100 mg/mL SolutionCannabidiol5Specialty Tier25%N/A
  • PA
EPINASTINE HYDROCHLORIDE .5 mg/mL Solution/ Drops2Generic$5.00$12.50None
EPINEPHRINE .15 mg/.15mL Injection3Preferred Brand25%25%None
EPINEPHRINE .15 mg/.3mL Injection3Preferred Brand25%25%None
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand25%25%None
EPINEPHRINE .3 mg/.3mL Injection3Preferred Brand25%25%None
EPLERENONE 25 mg Tablet, Film Coated2Generic$5.00$12.50None
EPLERENONE 50 mg Tablet, Film Coated2Generic$5.00$12.50None
EQUETRO 100 mg Capsule, Extended ReleaseCarbamazepine4Non-Preferred Drug25%25%None
EQUETRO 200 mg Capsule, Extended ReleaseCarbamazepine4Non-Preferred Drug25%25%None
EQUETRO 300 mg Capsule, Extended ReleaseCarbamazepine4Non-Preferred Drug25%25%None
ERAXIS 100 mg/30mL Injection, Powder, Lyophilized, For SolutionAnidulafungin5Specialty Tier25%N/ANone
ERAXIS 50 mg/15mL Injection, Powder, Lyophilized, For SolutionAnidulafungin4Non-Preferred Drug25%25%None
ERGOTAMINE TARTRATE AND CAFFEINE 1/100 mg Tablet, Film Coated3Preferred Brand25%25%
  • PA
ERIVEDGE 150 mg CapsuleVismodegib5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ERLEADA 240 mg Tablet, Film CoatedApalutamide5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ERLEADA 60 mg Tablet, Film CoatedApalutamide5Specialty Tier25%N/A
  • PA
  • QL 93 per 31 days
ERLOTINIB 100 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ERLOTINIB 150 mg Tablet, Film Coated5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ERLOTINIB 25 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ERTAPENEM 1 g/20mL InjectionErtapenem Sodium4Non-Preferred Drug25%25%None
ERY 20 mg/mL SwabErythromycin2Generic$5.00$12.50None
ERYTHROMYCIN 20 mg/g Gel2Generic$5.00$12.50
  • QL 6 per 28 days
ERYTHROMYCIN 20 mg/mL Solution2Generic$5.00$12.50
  • QL 6 per 28 days
ERYTHROMYCIN 250 mg Tablet, Coated4Non-Preferred Drug25%25%None
ERYTHROMYCIN 5 mg/g Ointment2Generic$5.00$12.50None
ERYTHROMYCIN 500 mg Tablet, Coated4Non-Preferred Drug25%25%None
ERYTHROMYCIN AND BENZOYL PEROXIDE 30/50 mg/g Gel2Generic$5.00$12.50None
ESCITALOPRAM 10 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 45 per 30 days
ESCITALOPRAM 15 mg Capsule4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
ESCITALOPRAM 20 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 3 per 30 days
ESCITALOPRAM 5 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 3 per 30 days
ESCITALOPRAM OXALATE 5 mg/5mL SolutionEscitalopram4Non-Preferred Drug25%25%
  • QL 62 per 31 days
ESLICARBAZEPINE ACETATE 200 mg Tablet4Non-Preferred Drug25%25%
  • QL 186 per 31 days
ESLICARBAZEPINE ACETATE 400 mg Tablet5Specialty Tier25%N/A
  • QL 93 per 31 days
ESLICARBAZEPINE ACETATE 600 mg Tablet5Specialty Tier25%N/A
  • QL 62 per 31 days
ESLICARBAZEPINE ACETATE 800 mg Tablet5Specialty Tier25%N/A
  • QL 62 per 31 days
ESOMEPRAZOLE MAGNESIUM 20 mg Capsule, Delayed Release2Generic$5.00$12.50
  • QL 31 per 31 days
ESOMEPRAZOLE MAGNESIUM 40 mg Capsule, Delayed Release2Generic$5.00$12.50
  • QL 31 per 31 days
ESTARYLLA KitNorgestimate And Ethinyl Estradiol2Generic$5.00$12.50None
ESTAZOLAM 1 mg Tablet2Generic$5.00$12.50
  • PA
ESTAZOLAM 2 mg Tablet2Generic$5.00$12.50
  • PA
ESTRADIOL .025 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .025 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .0375 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .0375 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .05 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .05 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .06 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .075 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .075 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .1 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .1 mg/d Patch2Generic$5.00$12.50None
ESTRADIOL .5 mg Tablet1Preferred Generic$0.00$0.00None
ESTRADIOL / NORETHINDRONE ACETATE .5/.1 mg Tablet, Film CoatedEstradiol And Norethindrone Acetate2Generic$5.00$12.50None
ESTRADIOL / NORETHINDRONE ACETATE 1/.5 mg Tablet, Film CoatedEstradiol And Norethindrone Acetate2Generic$5.00$12.50None
ESTRADIOL 1 mg Tablet1Preferred Generic$0.00$0.00None
ESTRADIOL 10 ug Insert4Non-Preferred Drug25%25%None
ESTRADIOL 2 mg Tablet1Preferred Generic$0.00$0.00None
ESTRADIOL VAGINAL .1 mg/g CreamEstradiol4Non-Preferred Drug25%25%None
ESTRING 2 mg SystemEstradiol4Non-Preferred Drug25%25%None
ESZOPICLONE 1 mg Tablet, Film Coated2Generic$5.00$12.50
  • PA
  • QL 31 per 31 days
ESZOPICLONE 2 mg Tablet, Film Coated2Generic$5.00$12.50
  • PA
  • QL 31 per 31 days
ESZOPICLONE 3 mg Tablet, Film Coated2Generic$5.00$12.50
  • PA
  • QL 31 per 31 days
ETHACRYNIC ACID 25 mg Tablet4Non-Preferred Drug25%25%None
ETHAMBUTOL HYDROCHLORIDE 100 mg Tablet2Generic$5.00$12.50None
ETHAMBUTOL HYDROCHLORIDE 400 mg Tablet2Generic$5.00$12.50None
ETHOSUXIMIDE 250 mg/5mL Solution2Generic$5.00$12.50None
ETODOLAC 200 mg Capsule3Preferred Brand25%25%None
ETODOLAC 300 mg Capsule3Preferred Brand25%25%None
ETODOLAC 400 mg Tablet, Extended Release3Preferred Brand25%25%None
ETODOLAC 400 mg Tablet, Film Coated2Generic$5.00$12.50None
ETODOLAC 500 mg Tablet, Extended Release3Preferred Brand25%25%None
ETODOLAC 500 mg Tablet, Film Coated2Generic$5.00$12.50None
ETODOLAC 600 mg Tablet, Film Coated, Extended Release3Preferred Brand25%25%None
ETONOGESTREL/ETHINYL ESTRADIOL .12/.015 mg/d Insert, Extended ReleaseEtonogestrel And Ethinyl Estradiol3Preferred Brand25%25%None
ETRAVIRINE 100 mg Tablet5Specialty Tier25%N/ANone
ETRAVIRINE 200 mg Tablet5Specialty Tier25%N/ANone
EULEXIN 125 mg CapsuleFlutamide4Non-Preferred Drug25%25%None
EVAMIST 1.53 mg SprayEstradiol4Non-Preferred Drug25%25%None
EVEROLIMUS .25 mg Tablet4Non-Preferred Drug25%25%
  • PA
EVEROLIMUS .5 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS .75 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS 1 mg Tablet5Specialty Tier25%N/A
  • PA
EVEROLIMUS 10 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
EVEROLIMUS 2 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
EVEROLIMUS 2.5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
EVEROLIMUS 3 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
  • QL 93 per 31 days
EVEROLIMUS 5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
EVEROLIMUS 5 mg Tablet, For Suspension5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
EVEROLIMUS 7.5 mg Tablet5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
EVOTAZ 300/150 mg TabletAtazanavir And Cobicistat5Specialty Tier25%N/ANone
EXEMESTANE 25 mg Tablet2Generic$5.00$12.50None
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
EXXUA 18.2 mg Tablet, Extended ReleaseGepirone4Non-Preferred Drug25%25%
  • PA
  • QL 64 per 365 days
EXXUA 36.3 mg Tablet, Extended ReleaseGepirone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
EXXUA 54.5 mg Tablet, Extended ReleaseGepirone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
EXXUA 72.6 mg Tablet, Extended ReleaseGepirone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
EZETIMIBE 10 mg Tablet2Generic$5.00$12.50None
EZETIMIBE AND SIMVASTATIN 10/10 mg Tablet3Preferred Brand25%25%
  • QL 31 per 31 days
EZETIMIBE AND SIMVASTATIN 10/20 mg Tablet3Preferred Brand25%25%
  • QL 31 per 31 days
EZETIMIBE AND SIMVASTATIN 10/40 mg Tablet3Preferred Brand25%25%
  • QL 31 per 31 days
EZETIMIBE AND SIMVASTATIN 10/80 mg Tablet3Preferred Brand25%25%
  • QL 31 per 31 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.