MedicarePartD.guide

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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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31 drugs starting with U.

Drug nameTier30-day preferred pharmacy90-day mail orderUsage management
UBRELVY 100 mg TabletUbrogepant5Specialty Tier25%N/A
  • PA
  • QL 17 per 28 days
UBRELVY 50 mg TabletUbrogepant5Specialty Tier25%N/A
  • PA
  • QL 34 per 28 days
ULTRAMICROSIZE GRISEOFULVIN 125 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug25%25%None
ULTRAMICROSIZE GRISEOFULVIN 250 mg Tablet, CoatedUltramicrosize Griseofulvin Tablets4Non-Preferred Drug25%25%None
UNITHROID 100 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 112 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 125 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 137 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 150 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 175 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 200 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 25 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 300 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 50 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 75 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UNITHROID 88 ug TabletLevothyroxine Sodium3Preferred Brand25%25%None
UPTRAVI 1000 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 1200 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 1400 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 1600 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 200 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 224 per 28 days
UPTRAVI 400 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 600 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI 800 ug Tablet, CoatedSelexipag5Specialty Tier25%N/A
  • PA
  • QL 62 per 31 days
UPTRAVI TITRATION PACK KitSelexipag5Specialty Tier25%N/A
  • PA
  • QL 4 per 365 days
URSODIOL 250 mg Tablet3Preferred Brand25%25%None
URSODIOL 300 mg Capsule3Preferred Brand25%25%None
URSODIOL 500 mg Tablet3Preferred Brand25%25%None
USTEKINUMAB 45 mg/.5mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 0.5 per 84 days
USTEKINUMAB 45 mg/.5mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 0.5 per 84 days
USTEKINUMAB 90 mg/mL Injection, Solution5Specialty Tier25%N/A
  • PA
  • QL 1 per 56 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.