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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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129 drugs starting with O.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
OCTREOTIDE 100 ug/mL Injection, SolutionOctreotide Acetate2Generic$5.00$12.50
  • PA
OCTREOTIDE 1000 ug/mL Injection, SolutionOctreotide Acetate3Preferred Brand25%25%
  • PA
OCTREOTIDE 500 ug/mL Injection, SolutionOctreotide Acetate4Non-Preferred Drug25%25%
  • PA
OCTREOTIDE ACETATE 200 ug/mL Injection, Solution4Non-Preferred Drug25%25%
  • PA
OCTREOTIDE ACETATE 50 ug/mL Injection, Solution2Generic$5.00$12.50
  • PA
ODACTRA 6/6 [arb'U] TabletDermatophagoides Pteronyssinus And Dermatophagoides Farinae4Non-Preferred Drug25%25%
  • PA
ODEFSEY 200/25/25 mg TabletEmtricitabine, Rilpivirine Hydrochloride, And Tenofovir Alafenamide5Specialty Tier25%N/A
  • QL 31 per 31 days
ODOMZO 200 mg CapsuleSonidegib5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OFEV 100 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OFEV 150 mg CapsuleNintedanib5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OFLOXACIN 3 mg/mL Solution2Generic$5.00$12.50None
OFLOXACIN 3 mg/mL SolutionOfloxacin Otic2Generic$5.00$12.50None
OGSIVEO 100 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OGSIVEO 150 mg Tablet, Film CoatedNirogacestat5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 16 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 2 per 28 days
OJEMDA 100 mg Tablet, Film CoatedTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 24 per 28 days
OJEMDA KitTovorafenib5Specialty Tier25%N/A
  • PA
  • QL 96 per 28 days
OJJAARA 100 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OJJAARA 150 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OJJAARA 200 mg TabletMomelotinib5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OLANZAPINE 10 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 10 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 10 mg/2mL Injection, Powder, Lyophilized, For Solution2Generic$5.00$12.50None
OLANZAPINE 15 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 15 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 2.5 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 20 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 20 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 5 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 5 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE 7.5 mg Tablet, Film Coated2Generic$5.00$12.50
  • QL 31 per 31 days
OLANZAPINE AND FLUOXETINE 12/25 mg CapsuleOlanzapine And Fuoxetine2Generic$5.00$12.50None
OLANZAPINE AND FLUOXETINE 12/50 mg CapsuleOlanzapine And Fuoxetine2Generic$5.00$12.50None
OLANZAPINE AND FLUOXETINE 3/25 mg CapsuleOlanzapine And Fuoxetine2Generic$5.00$12.50None
OLANZAPINE AND FLUOXETINE 6/25 mg CapsuleOlanzapine And Fuoxetine2Generic$5.00$12.50None
OLANZAPINE AND FLUOXETINE 6/50 mg CapsuleOlanzapine And Fuoxetine2Generic$5.00$12.50None
OLMESARTAN MEDOXOMIL / AMLODIPINE BESYLATE / HYDROCHLOROTHIAZIDE 40/10/12.5 mg Tablet, Film Coated3Preferred Brand25%25%None
OLMESARTAN MEDOXOMIL / AMLODIPINE BESYLATE / HYDROCHLOROTHIAZIDE 40/10/25 mg Tablet, Film Coated3Preferred Brand25%25%None
OLMESARTAN MEDOXOMIL 20 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 31 per 31 days
OLMESARTAN MEDOXOMIL 40 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 31 per 31 days
OLMESARTAN MEDOXOMIL 5 mg Tablet, Film Coated1Preferred Generic$0.00$0.00
  • QL 93 per 31 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 20/12.5 mg Tablet1Preferred Generic$0.00$0.00
  • QL 31 per 31 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/12.5 mg Tablet1Preferred Generic$0.00$0.00
  • QL 31 per 31 days
OLMESARTAN MEDOXOMIL AND HYDROCHLOROTHIAZIDE 40/25 mg Tablet1Preferred Generic$0.00$0.00
  • QL 31 per 31 days
OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 20/5/12.5 mg Tablet, Film Coated3Preferred Brand25%25%None
OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 40/5/12.5 mg Tablet, Film Coated3Preferred Brand25%25%None
OLMESARTAN MEDOXOMIL, AMLODIPINE AND HYDROCHLOROTHIAZIDE 40/5/25 mg Tablet, Film Coated3Preferred Brand25%25%None
OLOPATADINE HYDROCHLORIDE 665 ug Spray2Generic$5.00$12.50
  • QL 30.5 per 30 days
OMEGA-3-ACID ETHYL ESTERS 900 mg Capsule3Preferred Brand25%25%
  • QL 124 per 31 days
OMEPRAZOLE 10 mg Capsule, Delayed Release1Preferred Generic$0.00$0.00None
OMEPRAZOLE 20 mg Capsule, Delayed Release1Preferred Generic$0.00$0.00None
OMEPRAZOLE 40 mg Capsule, Delayed Release1Preferred Generic$0.00$0.00None
OMNITROPE 10 mg/1.5mL Injection, SolutionSomatropin5Specialty Tier25%N/A
  • PA
OMNITROPE 5 mg/1.5mL Injection, SolutionSomatropin4Non-Preferred Drug25%25%
  • PA
OMNITROPE KitSomatropin5Specialty Tier25%N/A
  • PA
ONDANSETRON 4 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • PA
ONDANSETRON 8 mg Tablet, Orally Disintegrating2Generic$5.00$12.50
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg Tablet, Film Coated2Generic$5.00$12.50
  • PA
ONDANSETRON HYDROCHLORIDE 4 mg/5mL Solution2Generic$5.00$12.50
  • PA
ONDANSETRON HYDROCHLORIDE 8 mg Tablet, Film Coated2Generic$5.00$12.50
  • PA
ONGENTYS 25 mg CapsuleOpicapone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
ONGENTYS 50 mg CapsuleOpicapone4Non-Preferred Drug25%25%
  • PA
  • QL 31 per 31 days
ONUREG 200 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
ONUREG 300 mg Tablet, Film CoatedAzacitidine5Specialty Tier25%N/A
  • PA
  • QL 14 per 28 days
OPIPZA 10 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
OPIPZA 2 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
OPIPZA 5 mg Film, SolubleAripiprazole5Specialty Tier25%N/A
  • PA
OPSUMIT 10 mg Tablet, Film CoatedMacitentan5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OPSYNVI 10/20 mg Tablet, Film CoatedMacitentan And Tadalafil5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
OPSYNVI 10/40 mg Tablet, Film CoatedMacitentan And Tadalafil5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ORENCIA 125 mg/mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ORENCIA 125 mg/mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 4 per 28 days
ORENCIA 50 mg/.4mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 1.6 per 28 days
ORENCIA 87.5 mg/.7mL Injection, SolutionAbatacept5Specialty Tier25%N/A
  • PA
  • QL 2.8 per 28 days
ORGOVYX 120 mg Tablet, Film CoatedRelugolix5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ORKAMBI 100/125 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ORKAMBI 100/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 124 per 31 days
ORKAMBI 150/188 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ORKAMBI 200/125 mg Tablet, Film CoatedLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 124 per 31 days
ORKAMBI 75/94 mg GranuleLumacaftor And Ivacaftor5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
ORLYNVAH 500/500 mg Tablet, Film CoatedSulopenem Etzadroxil And Probenecid4Non-Preferred Drug25%25%
  • QL 1 per 5 days
ORSERDU 345 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
  • QL 31 per 31 days
ORSERDU 86 mg Tablet, Film CoatedElacestrant5Specialty Tier25%N/A
  • PA
  • QL 93 per 31 days
OSELTAMIVIR PHOSPHATE 30 mg Capsule2Generic$5.00$12.50
  • QL 17 per 365 days
OSELTAMIVIR PHOSPHATE 45 mg Capsule2Generic$5.00$12.50
  • QL 9 per 365 days
OSELTAMIVIR PHOSPHATE 6 mg/mL Powder, For Suspension3Preferred Brand25%25%
  • QL 108 per 365 days
OSELTAMIVIR PHOSPHATE 75 mg CapsuleOseltamivir2Generic$5.00$12.50
  • QL 9 per 365 days
OTEZLA 20 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OTEZLA 30 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
OTEZLA 75 mg Tablet, Film CoatedApremilast5Specialty Tier25%N/A
  • PA
  • QL 3 per 30 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 11 per 365 days
OTEZLA KitApremilast5Specialty Tier25%N/A
  • PA
  • QL 82 per 365 days
OXACILLIN 1 g/20mL Injection, Powder, For Solution2Generic$5.00$12.50None
OXACILLIN 10 g/100mL Injection, Powder, For SolutionOxacillin Sodium4Non-Preferred Drug25%25%None
OXACILLIN 2 g/20mL Injection, Powder, For Solution2Generic$5.00$12.50None
OXAPROZIN 600 mg Tablet, Film Coated2Generic$5.00$12.50None
OXAZEPAM 10 mg Capsule, Gelatin Coated4Non-Preferred Drug25%25%
  • PA
OXAZEPAM 15 mg Capsule, Gelatin Coated4Non-Preferred Drug25%25%
  • PA
OXAZEPAM 30 mg Capsule, Gelatin Coated4Non-Preferred Drug25%25%
  • PA
OXCARBAZEPINE 150 mg Tablet, Extended Release4Non-Preferred Drug25%25%None
OXCARBAZEPINE 150 mg Tablet, Film Coated2Generic$5.00$12.50None
OXCARBAZEPINE 300 mg Tablet, Extended Release4Non-Preferred Drug25%25%None
OXCARBAZEPINE 300 mg Tablet, Film Coated2Generic$5.00$12.50None
OXCARBAZEPINE 300 mg/5mL Suspension2Generic$5.00$12.50None
OXCARBAZEPINE 600 mg Tablet, Extended Release5Specialty Tier25%N/ANone
OXCARBAZEPINE 600 mg Tablet, Film Coated2Generic$5.00$12.50None
OXISTAT 10 mg/mL LotionOxiconazole Nitrate4Non-Preferred Drug25%25%
  • ST
  • QL 6 per 28 days
OXYBUTYNIN 10 mg Tablet, Film Coated, Extended Release2Generic$5.00$12.50
  • QL 31 per 31 days
OXYBUTYNIN 5 mg Tablet, Film Coated, Extended Release2Generic$5.00$12.50
  • QL 31 per 31 days
OXYBUTYNIN CHLORIDE 15 mg Tablet, Extended Release3Preferred Brand25%25%
  • QL 62 per 31 days
OXYBUTYNIN CHLORIDE 5 mg Tablet2Generic$5.00$12.50None
OXYBUTYNIN CHLORIDE 5 mg/5mL Syrup2Generic$5.00$12.50None
OXYCODONE AND ACETAMINOPHEN 10/325 mg TabletOxycodone Hydrochloride And Acetaminophen3Preferred Brand25%25%
  • PA
  • QL 372 per 31 days
OXYCODONE AND ACETAMINOPHEN 2.5/325 mg Tablet3Preferred Brand25%25%
  • PA
  • QL 372 per 31 days
OXYCODONE AND ACETAMINOPHEN 5/325 mg TabletOxycodone Hydrochloride And Acetaminophen2Generic$5.00$12.50
  • PA
  • QL 372 per 31 days
OXYCODONE AND ACETAMINOPHEN 7.5/325 mg TabletOxycodone Hydrochloride And Acetaminophen2Generic$5.00$12.50
  • PA
  • QL 372 per 31 days
OXYCODONE HYDROCHLORIDE 10 mg Tablet2Generic$5.00$12.50
  • PA
  • QL 186 per 31 days
OXYCODONE HYDROCHLORIDE 100 mg/5mL Solution4Non-Preferred Drug25%25%
  • PA
  • QL 18 per 31 days
OXYCODONE HYDROCHLORIDE 15 mg Tablet2Generic$5.00$12.50
  • PA
  • QL 186 per 31 days
OXYCODONE HYDROCHLORIDE 20 mg Tablet2Generic$5.00$12.50
  • PA
  • QL 186 per 31 days
OXYCODONE HYDROCHLORIDE 30 mg Tablet3Preferred Brand25%25%
  • PA
  • QL 138 per 31 days
OXYCODONE HYDROCHLORIDE 5 mg Capsule2Generic$5.00$12.50
  • PA
  • QL 186 per 31 days
OXYCODONE HYDROCHLORIDE 5 mg Tablet2Generic$5.00$12.50
  • PA
  • QL 186 per 31 days
OXYTROL 3.9 mg/d PatchOxybutynin4Non-Preferred Drug25%25%
  • QL 8 per 28 days
OZEMPIC .68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 1.34 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 per 28 days
OZEMPIC 2.68 mg/mL Injection, SolutionSemaglutide3Preferred Brand25%25%
  • PA
  • QL 3 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.