Managed Care 247 Updates

9/2/2025 Removed: Desmopressin Nasal and Oral, Filgrastim, Jesduvroq, Korsuva, Rolvedon-Neulasta-and Related Biosimilars, Synarel, Zemplar Added: Imaavy, Vanrafia, Vykat XR

7/25/2025 Added: Gomekli, Niktimvo, Onapgo, Tryngolza

7/11/2025 Added Crenessity

Ventegra | PBM | updated: Mar 31, 2026

Ventegra Medication Policies Added: Inluriyo, Modeyso

3/12/2026 Added: Andembry, Brinsupri, Dawnzera, Ekterly, Ixifi

2/23/2026 Added: Akeega, Enhertu, Hernexeos, Hyrnuo, Rubraca, Talzenna, Zejula

2/5/2026 Added Sephience

1/30/2026 Added: Iwilfin, Lamzede, Wayrilz

12/7/2025 Added: Lynkuet, Simplera

9/27/2025 Added: Gomekli, Itovebi, Myobloc, Niktimvo, Revuforj, Rezurock

9/23/2025 Added: Leqvio, Vanrafia

7/28/2025 Removed Gleevec

7/25/2025 Added: Alyftrek, Amvuttra, Attruby, Bomyntra, Bonsity, Conexxence, Jubbonti,Onpattro, Osenvelt, Stoboclo, Vyndamax,Vyndaqel, Wainua Wyost

7/8/2025 Added Simlandi

6/18/2025 Added: Alhemo, Crenessity, Journavx, Sucraid, Tryngolza

5/8/2025 Added Danziten

4/2/2025 Added: Avtozma, Imuldosa, Pyzchiva, Selarsdi, Steqeyma, Yesintek

3/27/2025 Added: Aqneursa, Miplyffa

3/25/2025 Added: Oxervate, Voranigo, Yorvipath

3/12/2025 Added: Givlaari, Korlym, Lazcluze, Oxlumo, Rystiggo, Vyvgart, Zilbrysq

1/27/2025 Added: Evkeeza, Wezlana

12/18/2024 Added: Ohtuvayre

11/11/2024 Added: Camcevi, Eligard, Fensolvi, Ocrevus Zunovo, Synarel, Triptodur, Voydeya, Zoladex

Wellmark BCBS | Commercial | updated: Mar 31, 2026

Wellmark BCBS PA and QL Forms Added: Starjemza, Subvenite 2026

3/19/2026 Added: Forzinity, Itvisma, Jascayd, Leqembi, Palsonify, Redemplo, Rhapsido, Voyxact

2/27/2026 Removed: Adlyxin, ArmonAir, Breztri Aerosphere Added: Blenrep, Hyrnuo, Inlexzo, Keytruda Qlex, Komzifti, Kygevvi, Lymphir

2/21/2026 Added Lantidra

2/15/2026 Added: Jaythari, Kymbee, Pyquvi

12/5/2025 Removed: Carospir, Zorbtive Added: Anzupgo, Bkemv, Eculizumab, Epysqli, Livdelzi, Tryptyr, Tyruko, Wayrilz

11/3/2025 Added Simplera

10/24/2025 Removed Lucemyra Added Emrelis

10/10/2025 Added: Arynta, Atmekis, Brynovin, Leqselvi, Merilog, Vostally, Vyscoxa, Zevaskyn

10/3/2025 Added: Avtozma, Encelto, Ibtrozi, Jobevne, Lynozyfic, Ryoncil, Unloxcyt, Zegfrovy, Zusduri

9/13/2025 Added Andembry

9/9/2025 Added: Avmapki Fakzynja Co-Pack, Keratolytics Other Topical Dermatological Agents, Romvimza

9/5/2025 Added: Lazcluze, Voranigo

8/27/2025 Removed Zulresso Added Crenessity

8/14/2025 Added: Kynmobi, Lucemyra

8/1/2025 Added: Qfitlia, Vyalev, Vykat XR

7/26/2025 Added: Avmapki Fakzynja Co-Pack, Romvimza, Ryoncil

7/22/2025 Added Leqembi

7/17/2025 Added Raldesy, Ryzneuta

6/12/2025 Added Alhemo

5/24/2025 Added: Alyftrek, Bizengri, Gomekli, Kebilidi, Niktimvo, Tezruly, Tryngolza

3/24/2025 Added: Cobenfy, Hympavzi, Miplyffa, Tecelra, Ziihera

2/24/2025 Added: Ebglyss

2/15/2025 Added: Duvyzat, Yimmugo

2/10/2025 Added: Kanjinti, Latuda, Liraglutide, Nypozi,, Ogivri, Trastuzumab, Zunovo

2/06/2025 Removed: Oxbryta Added: Neulasta, Nivestym, Noritate, Nyvepria, Pexeva, Retacrit, Twyneo, Vimizim, Zarxio, Zerviate

1/31/2025 Added: Filsuvez, Monoferric, Venofer

1/10/2025 Added: Beqvez 11/14/2024 Added: Anktiva, PiaSky

March 27, 2026

AmeriHealth | Commercial | Effective: Apr 1, 2026

AmeriHealth Administrators Drug Program Formulary 2026

AmeriHealth | Medicare | Effective: Apr 1, 2026

AmeriHealth NJ Select Formulary 2026

AmeriHealth | Medicare | Effective: Apr 1, 2026

AmeriHealth NJ Value Formulary 2026

AmeriHealth | Medicare | Effective: Apr 1, 2026

AmeriHealth PA Value Formulary 2026

AmeriHealth | Medicare | Effective: Apr 1, 2026

AmeriHealth Select Drug Program Formulary 2026

Anthem BC | Commercial | updated: Mar 26, 2026

Anthem Medical Drug Clinical Criteria

IBC | Commercial | Effective: Apr 1, 2026

BC Independence Select Drug Program Formulary 2026

BCBS AZ | Commercial | updated: Mar 26, 2026

BCBS AZ Tiered Drug List Open Formulary Commercial 2026

BCBS AZ | Commercial | Effective: Mar 26, 2026

BCBS AZ Tiered Excluded Drug List Medications 2026

BCBS NE | Medicare | Effective: Mar 1, 2026

BCBS NE Medicare Advantage Access, Secure and Core Formulary 2026

BCBS ND | Medicare | Effective: Mar 2026

BCBS NE Medicare Advantage Connect PPO Formulary 2026

ConnectiCare | Commercial | Effective: Apr 1, 2026

ConnectiCare SOLO 4-Tier Formulary 2026

Dean Health Plan | Commercial | updated: Mar 1, 2026

Dean Health Plan Select 3-Tier Formulary 2026

Fallon Health | Commercial | Effective: May 11, 2026

Fallon Health MassHealth Drug List Summary Updates

Fallon Health | Commercial | Effective: Apr 17, 2026

Fallon Health Pharmacy Benefit Summary Updates

Fallon Health | Specialty Pharmacy | updated: Oct 2025

Fallon Health Specialty, Infused and Injectable Prescription Drugs 2025

10/25/2025 Added: Andembry, Eltrombopag, Leqselvi, Stoboclo

6/27/2025 Removed Fensolvi Added: Imaavy, Nilotinib, Jubbonti

2/01/2025 Added: Alvaiz, Hympavzi, Ebglyss, Imkeldi, Itovebi, Wezlana, Yusimry

9/26/2024 Added: Nemluvio and Prialt

9/01/2024 Added: Edaravone, Fensolvi, Kisunla, Pemrydi rtu, Tofidence

Humana | Medicare | Effective: Mar 2, 2026

Humana Medicare Employer Group 3 Formulary 2026

Humana | Medicare | Effective: Mar 1, 2026

Humana Medicare Employer Group 3 Prior Authorization Criteria 2026

Humana | Medicare | Effective: Mar 1, 2026

Humana Medicare Employer Group 3 Step Therapy Criteria 2026

IBC | Commercial | Effective: Apr 1, 2026

IBC Value Formulary 2026

Molina | Commercial | Effective: Apr 1, 2026

Molina Healthcare Affinity Essentials Plan Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare CA Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare FL Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare ID Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare IL Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare KY Passport Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare MS Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare NM Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare NV Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare OH Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare SC Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare UT Marketplace Formulary 2026

Molina | ACA | Effective: Apr 1, 2026

Molina HealthCare WA Marketplace Formulary 2026

March 24, 2026

BC of Idaho | Commercial | Effective: Mar 23, 2026

BC of Idaho Weekly Notifications Medical Provider Notifications

BC Premera AK | Policy | Effective: Mar 23, 2026

BC Premera AK Medical Policies Recent Updates

BCBS FL | Commercial | Effective: Apr 1, 2026

BCBS FL Florida Blue Commercial and Other Pharmacy Program Updates 2026

CommunityCare | ACA | Effective: Mar 1, 2026

CommunityCare ACA Small Group and Individual Formulary 2026

CommunityCare | Commercial | Effective: Mar 1, 2026

CommunityCare Commercial Large Group Formulary 2026

CommunityCare | ACA | Effective: Mar 1, 2026

CommunityCare Commercial Standardized Individual ACA Formulary 2026

CommunityCare | ACA | Effective: Mar 1, 2026

CommunityCare Individual ACA Standardized Formulary 2026

CommunityCare | ACA | Effective: Mar 1, 2026

CommunityCare Individual ACA Standardized Formulary 2026

CommunityCare | Commercial, ACA | Effective: Mar 1, 2026

CommunityCare Small Group and Individual ACA Formulary 2026

Geisinger | Medicare | Effective: Mar 1, 2026

Geisinger Health Plan Gold 6 T PA Policies 2026

Geisinger | Commercial | Effective: Feb 24, 2026

Geisinger Health Plan Gold 6 T RX Formulary 2026

HealthPartners | Commercial | updated: Feb 18, 2026

HealthPartners MSHO List of Covered Drugs List 2026

HealthPartners | Commercial | Effective: Mar 1, 2026

HealthPartners PreferredRx Drug Formulary 2026

Independent Health | Medicare | Effective: Mar 1, 2026

Independent Health Medicare Advantage Plans Step Therapy Criteria 2026

Kaiser Permanente | Commercial | Effective: Apr 1, 2026

Kaiser Permanente Comprehensive National Formulary 2026

Kaiser Permanente | Commercial | updated: Mar 2026

Kaiser Permanente Drugs Limited to Specific Pharmacies Added Nemluvio 2026

1/17/2026 Added: Hernexeos, Inluriyo, Livdelzi

Kaiser Permanente | Commercial | updated: Mar 17, 2026

Kaiser Permanente GHC Medications Serviced by Specialty Pharmacy 2026

Kaiser Permanente | Policy | updated: Mar 1, 2026

Kaiser Permanente Medical Benefit Injectable Drugs 2026

Presbyterian | Medicare | updated: Mar 1, 2026

Presbyterian Specialty and Medical Drugs 2026

March 20, 2026

BS CA | Commercial | Effective: Mar 1, 2026

BS CA Performance Formulary 2026

BS CA | Commercial | updated: Feb 2026

BS CA Performance Formulary Changes 2026

BS CA | Commercial | Effective: Mar 1, 2026

BS CA Plus Formulary 2026

BS CA | Medicare | updated: Feb 2026

BS CA Rx Plus Formulary 2026

BS CA | Commercial | Effective: Mar 1, 2026

BS CA Standard Formulary 2026

BS CA | Commercial | updated: Feb 2026

BS CA Standard Formulary Changes

BS CA | Commercial | Effective: Mar 1, 2026

BS CA Value DMC Formulary 2026

BS CA | Commercial | updated: Feb 2026

BS CA Value Formulary Changes 2026

CDPHP | Commercial | Effective: Feb 1, 2026

CDPHP Commercial Clinical Formulary 1 2026

CDPHP | Commercial | Effective: Feb 2026

CDPHP Commercial Clinical Formulary 1 2026

CDPHP | Commercial | updated: Feb 2026

CDPHP Commercial Exchange Formulary 2 2026

CDPHP | Commercial | updated: Feb 2026

CDPHP Commercial Formulary 2 2026

CDPHP | Commercial | updated: Feb 2026

CDPHP Formulary 1 Three-Tier Select Drug List 2026

CDPHP | Medicare | updated: Feb 2, 2026

CDPHP Medicare Advantage Group Enhanced Complete Formulary 2026

FHCP | Medicare | updated: Feb 18, 2026

FHCP Comprehensive Medicare RX Plus and Classic Formulary 2026

FHCP | Commercial | Effective: Mar 1, 2026

FHCP Grandfathered Commercial Plans 2026

FHCP | Medicare | updated: Feb 18, 2026

FHCP Medicare Prior Authorization Criteria 2026

FHCP | Medicare | updated: Feb 18, 2026

FHCP Medicare Step Therapy Criteria 2026

Harvard Pilgrim | Commercial | Effective: Mar 15, 2026

Harvard Pilgrim Core MA 3-Tier Formulary 2026

Harvard Pilgrim | Commercial | Effective: Mar 15, 2026

Harvard Pilgrim Core NH 5-Tier Formulary 2026

Harvard Pilgrim | Commercial | Effective: Mar 15, 2026

Harvard Pilgrim Core RI 5-Tier Formulary 2026

Harvard Pilgrim | Commercial | Effective: Mar 15, 2026

Harvard Pilgrim Value 5-Tier Formulary 2026

Horizon BCBS NJ | Medicare | updated: Mar 1, 2026

Horizon BCBS NJ TotalCare Formulary 2026

Medical Mutual | Policy | updated: Mar 20, 2026

Medical Mutual Drugs That May Require Prior Authorization Added: Ctexli, Lunsumio VELO, Onapgo, Voquezna

2/24/2026 Removed: Endari, Revlimid Added: Kymbee, Tryngolza

10/24/2025 Added: Aqneursa, Hernexeos, Modeyso, Miplyffa

9/24/2025 Revised Rheumatological Agents Added Alhemo

8/26/2025 Revised Rheumatological Agents Removed: Leqselvi, Oxaydo Added: Andembry, Lutrate Depot, Vtama, Zegfrovy, Zoryve

8/19/2025 Removed Humira Added Adalimumab Products

8/11/2025 Removed: Solaraze, Xgeva Added: Hympavzi, Ibtrozi

7/29/2025 Removed: Gamifant, Sensipar

7/22/2025 Added Qfitlia

5/13/2025 Removed Zavzpret Added Nubeqa

4/11/2025 Removed: Crexont, Ibsrela, Rytary; Added Attruby

4/1/2025 Added: Gomekli, Ruxience, Truxima

2/05/2025 Added: Azmiro, Danziten, Ebglyss, Ensacove, Imkeldi, Revuforj, Yargesa

1/15/2025 Removed: Viekira Added Ibsrela

12/10/2024 Removed: Mektovi, Added: Leqselvi, Tryvio

11/01/2024 Removed: Banzel, Luzu Added: Piasky, Tryvio

8/07/2024 Added: Dalfampridine, Voydeya, Winrevair, Xolremdi

PacificSource | Commercial | Effective: May 2026

PacificSource February Drug List Change Notification Commercial revised: Continuous Glucose Monitors, Wegovy

Wellmark BCBS | Commercial | revised: Mar 17, 2026

Wellmark BCBS New to Market List 2026

WPS Health Plan | Commercial | Effective: Apr 1, 2026

WPS Health Plan Medical Policy Updates

March 17, 2026

Anthem BC | Medicare | Effective: Mar 1, 2026

Anthem BC Medicare Preferred PPO with Senior Rx Plus Formulary 2026

Anthem BC | Medicare | Effective: Mar 1, 2026

Anthem BC MedicareRx PDP with Senior Rx Plus Formulary 2026

Anthem BC | Medicare | Effective: Mar 1, 2026

Anthem BC Preferred PPO with Senior Rx Plus Formulary 2026

Anthem BC | Medicare | Effective: Mar 1, 2026

Anthem BC Senior Secure HMO with Senior Rx Plus Formulary 2026

BC Independence | Specialty Pharmacy | Effective: Apr 1, 2026

BC Independence Specialty Pharmacy Benefit Drugs Select Drug Program 2026

BC Independence | Exclusions | updated: Apr 1, 2026

BC Independence Value Formulary Non-Covered Drug List 2026

BCBS AZ | ACA | Effective: Mar 12, 2026

BCBS AZ ACA Portfolio and PPO HSA Plans Formulary 2026

BCBS AZ | Commercial | Effective: Mar 12, 2026

BCBS AZ Standardized Plans PDL 2026

BCBS CareFirst | Commercial | Effective: Apr 1, 2026

BCBS CareFirst Formulary Updates 2026

BCBS Excellus | Dual | Effective: Mar 1, 2026

BCBS Excellus Dual Special Needs Prior Authorization Criteria 2026

BCBS Excellus | Commercial | updated: Mar 13, 2026

BCBS Excellus Upcoming Changes Essential Plan and 3-Tier Formulary 2026

BCBS FL | Medicare | Effective: Mar 15, 2026

BCBS FL What's New Medical Policy Updates

BCBS HI | Dual | Effective: Mar 1, 2026

BCBS HI HMSA Akamai Advantage Dual Care Formulary 2026

BCBS MI BCN | Specialty Pharmacy | updated: Mar 1, 2026

BCBS MI 15-Day Specialty Drug Limitation Program 2026

BCBS MT | ACA | Effective: Mar 1, 2026

BCBS MT Health Insurance Marketplace 4-Tier Formulary 2026

BCBS MT | Commercial | updated: Mar 17, 2026

BCBS MT Pharmacy Prior Authorization Forms Added: Anzupgo, Zepbound Kwikpen

1/15/2026 Added Inluriyo

7/26/2025 Added: Andembry, Bonsity, Ibtrozi, Imuldosa

5/23/2025 Added Ustekinumab

4/16/2025 Added: Purified Cortrophin Gel

2/17/2025 Added: Steqeyma, Yesintek

1/17/2025 Added: Crexont, Exkivity, Wezlana

12/16/2024 Added: Azmiro

12/02/2024 Added: Undecatrex

10/14/2024 Added: Eohilia, Filsuvez, Rivfloza, Zilbrysq

BCBS ND | Commercial | updated: Mar 1, 2026

BCBS ND Non-Payable Drug List 2026

CDPHP | Medicare | updated: Mar 2026

CDPHP Medicare Cumulative Formulary Updates 2026

Christus Health Plan | Commercial | updated: Feb 27, 2026

Christus Health Plan Individual and Family Health Exchange La, TX Formulary 2026

Cigna | Commercial | Effective: Mar 15, 2026

Cigna Coverage Policy Updates 2026

Harvard Pilgrim | Commercial | Effective: Mar 15, 2026

Harvard Pilgrim Premium 3-Tier Formulary 2026

Harvard Pilgrim | Commercial | updated: Mar 15, 2026

Harvard Pilgrim Premium 4-Tier Formulary 2026

HealthFirst | Commercial | updated: Mar 1, 2026

HealthFirst CompleteCare HMO Formulary 2026

HealthPartners | Commercial | Effective: Mar 14, 2026

HealthPartners Commercial Formulary PA and ST Coverage Criteria 2026

Cigna | Medicare | updated: Mar 1, 2026

HealthSpring Medicare Extra Rx PDP Formulary 2026

Medical Mutual | Commercial | Mar 2026

Medical Mutual Formulary Updates

Sentara | Commercial | updated: Mar 16, 2026

Sentara Health Plans Drug Authorization Forms Added Opsynvi

3/9/26 Added Tresiba

11/7/25 Added Empaveli- Pharmacy Policy

10/30/25 Added: Ekterly, Jaythari, Tryptyr, Vabrinty

10/15/25 Added Gamifant

10/2/25 Added: Datroway, Emblaveo, Enflonsia, Imaavy, Journavx, Leqselvi, Ridaura, Zelsuvmi

7/7/25 Added: Adasuve, Boruzu, Crenessity, Ctexli, Dalvance, Encelto, Fetroja, Fuzeon, Kepivance, Kimyrsa, Orbactiv, Qfitlia, Recarbrio, Sivextro, Teflaro, Tygacil, Vabomere, Vibativ

March 13, 2026

BCBS AZ | Exclusions | Effective: Mar 12, 2026

BCBS AZ Excluded Drug List QHP Plans Medications 2026 8/08/2024 Added: Tanlor

BCBS MI BCN | Medicare | Effective: Mar 1, 2026

BCBS MI BCN Advantage Classic, Prestige, Prime Value, Connected Care Core Comprehensive PA/ST Criteria 2026

BCBS MI BCN | Medicare | updated: Mar 2026

BCBS MI BCN QL and Dose Optimization Guidelines

BCBS VT | Policy | Effective: Mar 1, 2026

BCBS VT Medical PA Drugs 2026

Community Health Choice | Medicare | updated: Mar 1, 2026

Community Health Choice Comprehensive Formulary 2026

CommunityCare | Commercial | Effective: Mar 1, 2026

CommunityCare Commercial Small Group and Individual ACA Formulary 2026

Dean Health Plan | Medicare | Effective: Mar 1, 2026

Dean Health Plan Medicare Advantage Formulary 2026

EmblemHealth | Medicare | Effective: Mar 1, 2026

EmblemHealth NY Part D Prior Authorization Criteria 2026

Kaiser Permanente | Commercial | Effective: Mar 1, 2026

Kaiser Permanente Network Newsletter 2026

Quartz | Medicare | updated: Mar 1, 2026

Quartz Medication Prior Authorization List 2026

SelectHealth | Medicare | Effective: Mar 1, 2026

SelectHealth Medicare Essential Step Therapy List 2026

Sentara | Commercial | updated: Mar 12, 2026

Sentara Drug Authorization Forms Providers Added Tresiba 2026

11/4/2025 Added Wegovy - Metabolic Dysfunction

March 10, 2026

Aetna | Commercial | Effective: Mar 1, 2026

Aetna Banner Health Advanced Control Plans Self Insured Drug Guide 2026

Aetna | Medicare | Effective: Mar 1, 2026

Aetna Banner Health Standard Plans Self Insured Drug Guide 2026

Aetna | Medicare | Effective: Mar 1, 2026

Aetna Comprehensive PPO Medicare Plans Formulary 2026

Aetna | Medicare | Effective: Mar 1, 2026

Aetna Dual Select Medicare HMO D-SNP Plan Formulary 2026

Aetna | Medicare | Effective: Mar 1, 2026

Aetna Medicare Prime/Signature Plans Prior Authorization Criteria 2026

Aetna | Medicare | Effective: Mar 1, 2026

Aetna Medicare Prime/Signature Plans Step Therapy Criteria 2026

AmeriHealth | Commercial | Effective: Apr 2026

AmeriHealth AHA Accord Drug Formulary 2026

BCBS GA | Commercial | Effective: Mar 1, 2026

Anthem BCBS GA Medical Benefit Precertification List 2026

Anthem BCBS | Medicare | Effective: Mar 1, 2026

Anthem BCBS GA Specialty Pharmacy Updates

BCBS AR | Commercial | Effective: Mar 1, 2026

AR Blue BCBS Metallic 5-Tier Formulary 2026

BCBS AR | Commercial | Effective: Mar 1, 2026

AR Blue BCBS Metallic 6-Tier Formulary 2026

BCBS AL | Medicare | Effective: Mar 1, 2026

BCBS AL Part B Provider-Administered Drug List Added: Filkri, Inlexzo, Lunsumio Velo, Yartemlea 2026

BCBS AL | Commercial | updated: Mar 2026

BCBS AL SourceRx 1.0 Formulary

BCBS AL | Commercial | updated: Mar 2026

BCBS AL SourceRx 2.0 Formulary 2026

BCBS AL | Commercial | updated: Mar 2026

BCBS AL Standardized Source+ Rx 1.0 Formulary 2026

BCBS Highmark DE | Commercial | updated: Mar 2, 2026

BCBS DE Highmark Commercial Open/Incentive Comprehensive Formulary 2026

BCBS Excellus | ACA | Effective: Mar 1, 2026

BCBS Excellus Individual & Family Metal Plans Formulary 2026

BCBS FL | Medicare | updated: Mar 1, 2026

BCBS FL Care Choices for HSA Plans Medication Guide 2026

BCBS FL | Medicare | updated: Mar 1, 2026

BCBS FL Care Choices Medication Guide 2026

BCBS FL | Medicare | updated: Mar 1, 2025

BCBS FL ValueScript Rx Medication Guide 2025

BCBS HI | Commercial | updated: Mar 1, 2026

BCBS HI HMSA 2026 Akamai Advantage PPO Prior Authorization Criteria 2026

BCBS HI | Medicare | Effective: Mar 1, 2026

BCBS HI HMSA Akamai Advantage Standard/Plus/Complete/Plus 2026

BCBS HI | Policy | updated: Mar 1, 2026

BCBS HI HMSA Current Medical Policies 2026

Highmark | Commercial | Effective: Apr 1, 2026

BCBS Highmark Comprehensive Commercial Formulary Updates

BCBS IL | Medicare | Effective: Feb 11, 2026

BCBS IL Medicare Rx Basic Formulary 2026

BCBS IL | Medicare | Effective: Feb 11, 2026

BCBS IL Medicare Rx Value Formulary 2026

BCBS MA | Commercial | updated: Mar 1, 2026

BCBS MA Medicare Advantage 2 Tier Formulary 2026

BCBS MA | Commercial | updated: Mar 1, 2026

BCBS MA Medicare Advantage 3 Tier Formulary 2026

BCBS MI BCN | Medicare | updated: Mar 1, 2026

BCBS MI BCN Formulary for Prescription Blue PDP Select and Premium Updates 2026

BCBS TN | Commercial | Effective: Mar 1, 2026

BCBS TN Essential Plus Medication List 2026

BCBS TN | Medicare | Effective: Mar 1, 2026

BlueAdvantage Complete PPO Formulary 2026

BCBS TN | Medicare | Effective: Mar 1, 2026

BlueAdvantage Extra/Heart Diabetes Plus Formulary 2026

Highmark | Medicare | updated: Mar 1, 2026

Highmark Medicare Assured Diamond and Assured Ruby Formulary 2026

IBC | Medicare | Effective: Feb 18, 2026

IBC Keystone 65 Rx Preferred Rx HMO and PPO Plans Formulary 2026

IBC | Medicare | Effective: Mar 1, 2026

IBC Keystone/Personal Choice 65 Rx Select Option Prior Authorization 2026

IBC | Medicare | Effective: Mar 1, 2026

IBC Keystone/Personal Choice 65 Rx Select Option Step Therapy 2026

MVP Health Plans | ACA | Effective: Mar 1, 2026

MVP Health Plans Marketplace Formulary 2026

Paramount | Commercial | Effective: Mar 1, 2026

Paramount Adaptive Rx Commercial Select Formulary 2026

Paramount | Commercial | updated: Mar 2026

Paramount Health Drugs that Require a PA 2026

Scripps Health Plan | Commercial | updated: Mar 1, 2026

Scripps Health Plan MedPerform High Formulary 2026

Sentara | Commercial | Effective: Jun 1, 2026

Sentara Health Plans Medical and Clinical Policy Updates

Sentara | Commercial | Effective: May 1, 2026

Sentara Health Plans Medical and Clinical Policy Updates 2026

March 06, 2026

AlohaCare | Medicare | Effective: Mar 1, 2026

AlohaCare Optum Rx Advantage/Plus Plan Formulary Changes

AmeriHealth | Medicare | Effective: Mar 1, 2026

AmeriHealth Prime Therapeutics Specialty Drug Management List 2026

Anthem BC | Commercial | updated: Mar 1, 2026

Anthem BC Traditional 3 Tier Drug List 2026

Anthem BC | Commercial | updated: Mar 1, 2026

Anthem BC Traditional Open Solutions 3 Tier Drug List

Atrio Health Plan | Medicare | updated: Mar 5, 2026

Atrio Health Plan Part B PA/ST Drug Grid 2026

IBC | Commercial | Effective: Apr 1, 2026

BC Independence IA Value Formulary Updates

IBC | Commercial | Effective: Apr 1, 2026

BC Independence IA Value with PA Formulary Updates

BC Independence | Commercial | Effective: Apr 1, 2026

BC Independence Select Formulary IA Prescription Drug Changes

BC Independence | Commercial | Effective: Apr 1, 2026

BC Independence Select Formulary IA With PA Prescription Drug Changes

BC Independence | Medicare | Effective: Apr 1, 2026

BC Independence Select Formulary Updates

BC Independence | Commercial | Effective: Apr 1, 2026

BC Independence Value Formulary Updates

BC Premera | Commercial | Effective: Mar 1, 2026

BC Premera Metallic M1 Formulary 2026

BCBS AZ | Commercial | Effective: May 5, 2026

BCBS AZ High Deductible Health Plan Preventive Medication Open List 2026

BCBS AZ | Commercial | updated: Mar 5, 2026

BCBS AZ Vaccines Covered Under the Pharmacy Benefit List 2026

8/1/2025 Added Menquadfi

8/08/2024 Added: Biothrax, Rabavert, Rotarix, Rotateq

BCBS IL | ACA | Effective: Mar 1, 2026

BCBS IL Marketplace 4 Tier Formulary 2026

BCBS IL | ACA | Effective: Mar 1, 2026

BCBS IL Marketplace 6 Tier Formulary 2026

BCBS IL | ACA | Effective: Mar 1, 2026

BCBS IL Marketplace HMO POS 4 Tier Formulary 2026

BCBS IL | ACA | Effective: Mar 1, 2026

BCBS IL Marketplace HMO POS 6 Tier Formulary 2026

BCBS IL | Medicare | Effective: Mar 1, 2026

BCBS IL Medicare Advantage Basic/Plus/Premier Plus/Value/Choice Plus/Premier/Essential/Classic/Elite/Secure Comprehensive Formulary 2026

BCBS KS | Commercial | Effective: Mar 1, 2026

BCBS KS Blue Medicare Advantage/Comprehensive/Choice Formulary 2026

BCBS MA | Policy | Mar 1, 2026

BCBS MA Medical Policy Updates

BCBS ND | ACA | Effective: Mar 2026

BCBS ND Market Individual Small Group 4-Tier Formulary 2026

BCBS ND | ACA | Effective: Mar 2026

BCBS ND Market Individual Small Group 6-Tier Formulary 2026

IBC | Medicare | updated: Mar 2026

IBC 2026 Keystone/Personal Choice 65 Rx Select Option 5-Tier Open Prior Authorization Criteria 2026

IBC | Medicare | updated: Mar 2026

IBC 2026 Keystone/Personal Choice 65 Rx Select Option 5-Tier Open Step Therapy 2026

IBC | Medicare | Effective: Feb 18, 2026

IBC Keystone 65 Rx HMO, Personal Choice 65 Rx PPO and Select Option PDP Formulary 2026

Prime Therapeutics | Medicare | updated: Mar 1, 2026

Prime Therapeutics Specialty Drug Management List 2026 2/01/2025 Added: Aucatzyl

United Healthcare | Commercial | updated: Jun 1, 2026

United Healthcare Commercial Clinical Pharmacy PA, Notification and Medical Necessity Requirements Removed Lidoderm 12/1/2025 Added: Empaveli, Gomekli, Hympavzi, Lucemyra, Qfitlia, Romvimza, Viberzi

Univera | Medicare | Effective: Mar 5, 2026

Univera Medical Specialty Drug Preauthorization Requirements 2026

March 03, 2026

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Choice Plan Formulary Updates

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Plan - Aetna CA Formulary Updates

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Plan - Aetna Formulary Updates

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Plan - Aetna IL Formulary Updates

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Plan - Aetna WV Formulary Updates

Aetna | Medicare | Effective: Apr 1, 2026

Aetna Advanced Control Plan Formulary Updates

Aetna | ACA | Effective: Apr 1, 2026

Aetna Health Exchange CA OAMC/PPO Plan Formulary Updates

Aetna | ACA | Effective: Apr 1, 2026

Aetna Health Exchange Plan CA HMO Formulary Updates

Aetna | ACA | Effective: Apr 1, 2026

Aetna Health Exchange Plan FL Formulary Updates

Aetna | ACA | Effective: Apr 1, 2026

Aetna Health Exchange Plan Formulary Updates

Anthem BC | Commercial | updated: Mar 1, 2026

Anthem BC CA DMHC 3 Tier Drug List List 2026

Anthem BC | Commercial | updated: Mar 1, 2026

Anthem BC CA DMHC 4 Tier Drug List List 2026

BCBS MI BCN | Medicare | Effective: Mar 1, 2026

BCBS MI Blue Cross and BCN Utilization Management Medical Drug List 2026

BS CA | Medicare | updated: Feb 18, 2026

BS CA Rx Enhanced Formulary 2026

BS CA | Medicare | Effective: Mar 1, 2026

BS CA Rx Enhanced Prior Authorization Criteria 2026

BS CA | Medicare | Effective: Mar 1, 2026

BS CA Rx Enhanced Step Therapy Criteria 2026

BSW Health Plan | Medicare | Effective: Mar 2026

BSWHP SeniorCare Advantage Essentials Plans Formulary 2026

BSW Health Plan | Medicare | Effective: Mar 2026

BSWHP SeniorCare Advantage Rx Formulary 2026

CVS/Caremark | Policy | updated: Mar 2, 2026

CVS/Caremark FEP PA Forms Added Zavzpret

2/26/2026 Added: cladribine, Ensacove, Qfitlia

12/5/2025 Added: Alhemo, Alyftrek, Crenessity, Romvimza, Tryngolza, Xromi

8/19/2025 Added Enflonsia

8/1/2025 Added: Ibtrozi, Posfrea

7/24/2025 Added: Ebglyss, Hympavzi, Ocrevus Zunovo

7/14/2025 Added: Aqneursa, Attruby, Danziten, Leukine, Torpenz

7/10/2025 Removed Vyloy

6/14/2025 Added Ctexli

4/10/2025 Added: Hulio, Tyenne

4/4/2025 Removed: Tevimbra, Zepbound Added: Datroway, Journavx, Opdivo Qvantig,

2/04/2025 Removed: Aquoral Bocasal, Caphosol, Columvi, Elrexfio, Gelclair, Mozobil, Neutrasal, Vyxeos Added: Altinac, Rezdiffra

12/27/2024 Added: Altinac

12/16/2024 Added: Tevimbra, Vyloy

12/02/2024 Removed: Columvi, Elrexfio, Mozobil, Vyxeos Added: Altinac, Itovebi

EmblemHealth | Commercial | Effective: Mar 1, 2026

EmblemHealth Essential Plan, Individual and Family Plans and Small Group Formulary 2026

EmblemHealth | Medicare | Effective: Mar 1, 2026

EmblemHealth HMO and PPO Formulary 2026

EmblemHealth | Medicare | Effective: Mar 1, 2026

EmblemHealth HMO D-SNP Formulary 2026

EmblemHealth | Medicare | Effective: Mar 1, 2026

EmblemHealth PDP GCI Enhanced/Standard Formulary 2026

FHCP | Commercial | Effective: Mar 1, 2026

FHCP Commercial Non Grandfathered Plans Formulary 2026

FHCP | Commercial | Effective: Mar 1, 2026

FHCP QHP Standardized Plans Formulary 2026

Horizon BCBS NJ | Commercial | Approved: Q1 2026

Horizon BCBS NJ AMT Formulary Changes

Horizon BCBS NJ | Commercial | Approved: Q1 2026

Horizon BCBS NJ Enhanced NetResults Formulary Updates

Horizon BCBS NJ | ACA | Effective: Mar 1, 2026

Horizon BCBS NJ Marketplace Formulary 2026

Horizon BCBS NJ | ACA | Approved: Q1

Horizon BCBS NJ Marketplace Formulary Changes

Horizon BCBS NJ | Commercial | Effective: Mar 1, 2026

Horizon BCBS NJ Medicare Blue Rx Enhanced Formulary 2026

Horizon BCBS NJ | Commercial | Approved: Q1 2026

Horizon BCBS NJ NetResults Plus Formulary Updates

Molina | Medicare | Effective: Mar 1, 2026

Molina Healthcare Choice Care/Select HMO Formulary 2026

Paramount | ACA | updated: Mar 1, 2026

Paramount Health ACA/Alliance Preferred Formulary 2026

Paramount | ACA | Effective: Mar 1, 2026

Paramount Health Insurance Marketplace 4 Tier Standard Formulary 2026

Paramount | ACA | Effective: Mar 1, 2026

Paramount Health Insurance Marketplace 6 Tier Standard Formulary 2026

Paramount | Medicare | Effective: Mar 1, 2026

Paramount Health Preferred/Standard/Prime/Enhanced Formulary 2026

Presbyterian | Medicare, Dual | Effective: Feb 18, 2026

Presbyterian Medicare Advantage Dual Plus Senior Care/UltraFlex Formulary Updates

South Country Health Alliance | Commercial | Effective: Mar 1, 2026

South Country Health Alliance Complete 1-Tier Prior Authorization Criteria 2026

South Country Health Alliance | Commercial | Effective: Mar 1, 2026

South Country Health Alliance Complete 1-Tier Step Therapy Criteria 2026

South Country Health Alliance | Commercial | Effective: Mar 1, 2026

South Country Health Alliance SeniorCare Complete AbilityCare Formulary 2026

Tufts | Medicare | updated: Mar 1, 2026

Tufts Health Plan Medicare Preferred Step Therapy Guidelines 2026

RMHP | Commercial | Effective: Apr 1, 2026

UHC RMHP Preferred Drug List Updates 2026

United Healthcare | Commercial | updated: Mar 1, 2026

United HealthCare Commercial Review at Launch Medication List

United Healthcare | Commercial | Mar 2026

United Healthcare Monthly Overview 2026

United Healthcare | Commercial | Effective: Mar 1, 2026

United Healthcare Pharmacy Bulletin for UnitedHealthcare Commercial 2026

United Healthcare | Commercial | updated: Mar 1, 2026

United Healthcare Review at Launch for New to Market Medications Commercial Medical Drug Policy 2026

United Healthcare | Commercial | updated: Mar 1, 2026

United Healthcare River Valley Commercial Medical & Drug Policies and Coverage Determination Guidelines 2026

Univera | Dual | Effective: Mar 1, 2026

Univera Medicare Dual Formulary 2026

Univera | Medicare | Effective: Mar 1, 2026

Univera Part D PA Policy 2026

Univera | Medicare | Effective: Mar 1, 2026

Univera Part D ST Policy 2026

February 27, 2026

Aetna | Commercial | Mar 2026

Aetna OfficeLink Newsletter Updates

BCBS AL | Commercial | Effective: Feb 18, 2026

BCBS AL BlueRx Essential Formulary 2026

BCBS IL | Commercial, Dual | updated: Apr 1, 2026

BCBS IL Prior Authorization Changes for Some Commercial and Government Program Members

BCBS KS | Policy | Effective: Feb 24, 2026

BCBS KS Medical Policies Updates 2026

BCBS NM | Commercial | Effective: Apr 1, 2026

BCBS NM Prior Authorization Changes for Some Commercial and Government Program Members 2026

BCBS OK | Commercial | Effective: Apr 1, 2026

BCBS OK Prior Authorization Changes for Some Commercial and Government Program Members 2026

BCBS TN | Commercial, Medicare | May 2, 2026

BCBS TN Upcoming Medical Policies

BCBS TX | Commercial, Dual | Effective: Apr 1, 2026

BCBS TX News and Updates Prior Authorization Changes for Some Commercial and Government Program Members

BCBS AL | Medicare | Effective: Feb 18, 2026

BlueRx Essential Plus Formulary 2026

BS CA | Commercial | Effective: Mar 1, 2026

BS CA Commercial Prior Authorization List 2026

BS CA | Medicare | Effective: Mar 1, 2026

BS CA Medicare Prior Authorization List 2026

ConnectiCare | ACA | updated: Mar 2026

ConnectiCare Employer 3-Tier Formulary 2026

ConnectiCare | Commercial | updated: Mar 2026

ConnectiCare Employer 4-Tier Formulary 2026

Dean Health Plan | Commercial | updated: Mar 1, 2026

Dean Health Plan Master Service List 2026

EmblemHealth | Medicare | updated: Feb 10, 2026

EmblemHealth EH Enterprise Preauthorization List 2026

HealthPartners | Policy | Effective: Feb 27, 2026

HealthPartners Coverage Criteria Policies Removed Macrilen

10/5/2025 Added: Amvuttra, Encelto, Kisunla, Ryoncil

8/27/2025 Added Niktimvo

8/01/25 Added Yeztugo

7/15/25 Added Datroway

6/27/25 Added Kebilidi

6/16/25 Added Zevaskyn

6/03/2025 Added Ocrevus Zunovo

1/21/2025 Removed: Zymfenta

10/01/2024 Added: Beqvez, Lenmeldy

Kaiser Permanente | Commercial | Effective: Mar 1, 2026

Kaiser Permanente Large Group Access Pharmacy Benefit Plans Formulary 2026

Medica | Commercial | updated: Mar 2026

Medica Commercial Drug List with ACA Preventive Drugs Formulary 2026

Medica | Medicare | Effective: Mar 1, 2026

Medica Medicare Part D Closed Formulary 2026

Western Health | Commercial | Effective: Mar 1, 2026

Western Health Advantage Optum Rx 4-Tier Essential Health Benefits Base Formulary Preferred Drug List 2026

February 24, 2026

Aetna | Commercial | updated: Mar 1, 2026

Aetna Precertification List 2026

BCBS CareFirst | ACA | Effective: Feb 1, 2026

BCBS CareFirst Complete Exchange Formulary 2026

BCBS CareFirst | Commercial | Effective: Feb 1, 2026

BCBS CareFirst Specialty Drugs List 2026

BCBS HI | Commercial | updated: Feb 23, 2026

BCBS HI Medical Specialty Drug Policies V-Z

Capital Health Plan BCBS | Commercial | updated: Mar 2026

Capitol Health Plan Medications Obtained Through the Medical Benefit 2026

Horizon BCBS NJ | Policy | Effective: Apr1, 2026

Horizon BCBS NJ Injectable Medications subject to Medical Necessity and Appropriateness Review 11/01/2024 Added: Hympavzi, Imuldosa, Pablu, Vyloy

PacificSource | Commercial | Effective: Feb 23, 2026

PacificSource Health Plans Complete Preferred Formulary 2026

PacificSource | Commercial | updated: Feb 23, 2026

PacificSource Health Plans ID Complete Formulary 2026

PacificSource | Commercial | Effective: Feb 23, 2026

PacificSource Health Plans MT Complete Formulary 2026

PacificSource | Commercial | Effective: Feb 23, 2026

PacificSource Health Plans OR Complete Formulary 2026

PacificSource | Commercial | Effective: Feb 23, 2026

PacificSource Health Plans WA Complete Formulary 2026

February 20, 2026

BCBS CareFirst | Commercial | Effective: Feb 1, 2026

BCBS CareFirst Formulary 3 5-Tier 2026

BCBS Excellus | Medicare | updated: Feb 19, 2026

BCBS Excellus Oncology Clinical Review Prior Authorization Medical Drugs 2026

CDPHP | Commercial | Effective: Feb 12, 2026

CDPHP Formulary 2 Updates

Premera BC | Policy | Effective: Feb 1, 2026

Premera BC Pharmacotherapy of Miscellaneous Autoimmune Diseases Pharmacy/Medical Policy 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 3-Tier Access Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 3-Tier Access Formulary Updates 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 3-Tier PDL Formulary Updates

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 3-Tier Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 4-Tier Access Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 4-Tier Access Formulary Updates 2026

United Healthcare | Medicare | updated: May 1, 2026

United Healthcare Advantage 4-Tier PDL Formulary Updates 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Advantage 4-Tier Prescription Drug List for UnitedHealthcare, Neighborhood Health Plan, River Valley, All Savers, and Oxford medical plans Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Essential 4-Tier Access Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Essential 4-Tier Access Formulary Updates 2026

United Healthcare | Commercial | Effective: May 1, 2026

United Healthcare Specialty Savings Rx 4-Tier Formulary Updates 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Traditional 3-Tier Access Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Traditional 3-Tier Access Formulary Updates 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Traditional 4-Tier Access Formulary 2026

United Healthcare | Medicare | Effective: May 1, 2026

United Healthcare Traditional 4-Tier Access Formulary Updates 2026

Valley Health Plan | Commercial | updated: Feb 2026

Valley Health Plan CA Individual and Family Group Formulary Updates 2026

Valley Health Plan | Commercial | updated: Feb 2026

Valley Health Plan CA Individual and Family Plan Formulary 2026

Valley Health Plan | Commercial | updated: Feb 1, 2026

Valley Health Plan Employer Group Classic/Preferred Plan Drug Formulary 2026

Valley Health Plan | Commercial | updated: Feb 2026

Valley Health Plan Employer Group Formulary Updates 2026

February 17, 2026

BCBS AL | Policy | Effective: Feb 16, 2026

BCBS AL Continuous Glucose Monitor PA With QL Program Summary

BCBS AZ | Commercial | updated: Feb 13, 2026

BCBS AZ Pharmacy Benefit Specialty Medication List 2026 8/08/2024 Added: Vafseo

BCBS HI | Dual | updated: Feb 1, 2026

BCBS HI HMSA 2026 Dual Care Plans Prior Authorization Criteria 2026

BCBS KS | Commercial | Effective: Feb 1, 2026

BCBS KS BlueCare/EPO Medication List 2026

BCBS KS | Commercial | updated: Feb 1, 2026

BCBS KS Formulary for BlueCare Standardized Products 2026

BCBS NM | Commercial | updated: Feb 2026

BCBS NM Blue Review Provider Newsletter

BCBS NM | ACA | Effective: Feb 1, 2026

BCBS NM Health Insurance Exchange 5 Tier Drug List 2026

BCBS NM | ACA | Effective: Feb 1, 2026

BCBS NM Health Insurance Exchange 6 Tier Drug List 2026

BCBS OK | ACA | Effective: Feb 1, 2026

BCBS OK Health Insurance Marketplace 4 Tier Formulary 2026

BCBS OK | ACA | Effective: Feb 1, 2026

BCBS OK Health Insurance Marketplace 6 Tier Formulary 2026

BCBS TX | Commercial | Effective: Feb 1, 2026

BCBS TX Marketplace 4 Tier Formulary 2026

BCBS TX | Commercial | Effective: Feb 1, 2026

BCBS TX Marketplace 6 Tier Formulary 2026

Cigna | Commercial | Effective: Feb 15, 2026

Cigna Coverage Policy Updates 2026

QualChoice | Commercial | Effective: Apr 1, 2026

QualChoice News Page Pharmacy Policy Changes 2026

SummaCare | ACA | Effective: Feb 1, 2026

SummaCare Marketplace Non-Standard Prescription Drug Formulary 2026

SummaCare | ACA | Effective: Feb 1, 2026

SummaCare Marketplace Standard Prescription Drug Formulary 2026

February 13, 2026

BCBS NC | Commercial | updated: Feb 11, 2026

BCBS NC Commercial Medical Policy Updates 2026

MetroPlus | ACA | Effective: Feb 1, 2026

MetroPlus GoldCare Comprehensive Formulary 2026

MetroPlus | Medicare | Effective: Feb 1, 2026

MetroPlus Health Advantage Plan Formulary Updates 2026

MetroPlus | Medicare | Effective: Feb 1, 2026

MetroPlus Health Medicare Advantage Comprehensive Formulary 2026

MetroPlus | Medicare | Effective: Feb 1, 2026

MetroPlus Medicare UltraCare and Platinum Formulary 2026

PacificSource | Medicare | updated: Feb 1, 2026

PacificSource Medicare Essential PERS Rx Formulary 2026

February 10, 2026

BCBS AL | Commercial | updated: Feb 10, 2026

BCBS AL Prime Provider Administered Specialty Pharmacy Drug List Added: Ahzantive, Bildyos, Bilprevda, Enoby, Enzeevu, Eydenzelt Opuviz, Pavblu, Qivigy, Yesafili, Xtrenbo 2026 1/19/2026 Added: Bomyntra, Conexxence, Denosumab, Jubbonti, Osenvelt, Ospomyv, Stoboclo, Wyost, Xbryk

BCBS AL | Specialty Pharmacy | updated: Feb 10, 2026

BCBS AL Self Administered Specialty Pharmacy Drug List Added: Leqselvi, Otezlaxa, Pyzchiva Selarsdi 2026

BCBS HI | Specialty Pharmacy | updated: Feb 6, 2026

BCBS HI Medical Specialty Drug Policies: A-C

HealthFirst | Medicare | Effective: Feb 1, 2026

HealthFirst 65 Plus Plan Monthly Formulary Changes 2026

HealthFirst | Medicare | Effective: Feb 1, 2026

HealthFirst CompleteCare Monthly Formulary Changes 2026

HealthFirst | Medicare | Effective: Feb 1, 2026

HealthFirst Connection Plan Monthly Formulary Changes 2026

HealthFirst | Medicare | Effective: Feb 1, 2026

HealthFirst Increased Benefits Plan Monthly Formulary Changes 2026

HealthFirst | Medicare | Effective: Feb 1, 2026

HealthFirst Life Improvement Plan Monthly Formulary Changes 2026

HealthFirst | Commercial, Medicare | Effective: Feb 1, 2026

HealthFirst Signature HMO Monthly Formulary Changes 2026

HealthFirst | Commercial, Medicare | Effective: Feb 1, 2026

HealthFirst Signature PPO Monthly Formulary Changes 2026

HealthPartners | Commercial | Effective: Apr 1, 2026

HealthPartners Commercial Formulary Changes 2026

Hometown Health | Commercial | Effective: Jan 1, 2026

Hometown Health Optum Rx Essential Health Benefits Base Formulary 2026

February 06, 2026

Aetna | Medicare | Effective: Feb 1, 2026

Aetna SilverScript Choice Medicare Formulary Changes 2026

BC Premera | Commercial | Effective: Feb 1, 2026

BC Premera Essentials E4 HMO Formulary Drug List Changes 2026

BC Premera | Medicare | Effective: Apr 1, 2026

BC Premera Upcoming Complete Formulary Changes 2026

BCBS AL | Specialty Pharmacy | updated: Feb 2026

BCBS AL Blue Advantage Part B Provider-Administered Precertification Drug List Added: Cligavyx, Exdensur, Itvisma, Rybrevant Faspro 2026 11/1/2025 Added Keytruda Qlex

IBC | Commercial | Effective: Feb 1, 2026

IBC Keystone/Personal Choice 65 Rx Select Option 5-Tier Open Prior Authorization 2026

IBC | Commercial | Effective: Feb 1, 2026

IBC Keystone/Personal Choice 65 Rx Select Option Step Therapy 2026

IBC | Medicare | Effective: Jan 20, 2026

IBC Medicare Keystone 65 Rx and Personal Choice 65 Rx Formulary 2026

February 03, 2026

Aetna | Commercial | Effective: Feb 1, 2026

Aetna Banner Advanced Control Plan Formulary 2026

Aetna | Commercial | Effective: Feb 1, 2026

Aetna Banner Health Advanced Control Plan Specialty Drug List 2026

AlohaCare | Commercial | Effective: Feb 1, 2026

AlohaCare Provider Update Carelon Rx Monthly Pharmacy Formulary Changes

CVS/Caremark | Commercial | updated: Apr 2026

CVS/Caremark Advanced Control Formulary 2026

CVS/Caremark | Commercial | Effective: Apr 2026

CVS/Caremark Standard Control Formulary 2026

HAP | Medicare | Effective: Feb 1, 2026

HAP Express Scripts Medicare Part D Formulary Changes 2026

Molina | Medicare | updated: Feb 1, 2026

Molina Healthcare Medicare Complete Care Formulary 2026

Presbyterian | Medicare | Effective: Jan 1, 2026

Presbyterian Centennial Care Plans Formulary Changes

January 30, 2026

Anthem BCBS | Medicare | updated: Jan 1, 2026

Anthem BCBS 2025 CarlonRx Exclusive Specialty Drug List Updated Jan 1, 2026CarlonRx Exclusive Specialty Drug List 2026

Anthem BCBS | Policy | updated: Jan 28, 2026

Anthem BCBS Clinical Criteria Added: Armlupeg, Blenrep, Osvyrti, Jubereq, Redemplo, Voyxact

10/15/2025 Added: Apretude, Papzimeos, Yeztugo

7/24/2025 Added Bkemv

6/13/2025 Removed Fusilev Added: Conexxence, Bomyntra, Imaavy, Jobevne

4/10/2025 Added: Avtozma, Onapgo, Osenvelt, Ospomyv, Stoboclo, Xbryk

3/26/2025 Added: Docivyx

1/20/2025 Added: Bizengri, Yesintek,Ziihera

9/25/2024 Added: Ahzantive, Enzeevu, Opuviz, Pavblu, Yesafili

Anthem BCBS | Commercial | Effective: May 1, 2026

Anthem BCBS GA News Page Expands Specialty Pharmacy Precertification List 2026

BCBS MA | Medicare | Effective: Jan 1, 2026

BCBS MA Medicare HMO Blue Saver/Value/Flex/Plus Rx Formulary 2026

BCBS MI BCN | Commercial | Effective: Feb 1, 2026

BCBS MI BCN Network Preferred Formulary 2026

BCBS MI BCN | Commercial | updated: Feb 1, 2025

BCBS MI BCN Preferred Drug List PA and ST Guidelines 2025

BCBS MI BCN | Medicare | Effective: Jan 21, 2026

BCBS MI Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue and BCN Advantage Members 2026

BCBS MT | Commercial | Effective: Jan 1, 2026

BCBS MT Preferred Drug Strategy for Medical Benefit Drugs with Therapeutic Equivalents or Alternatives To Be Covered Through Enhanced Prior Authorization 2026

BCBS MT | Commercial | updated: Jan 28, 2026

BCBS MT Prior Authorization Changes for Some Commercial and Government Program Members 2026

BCBS TN | Medicare | updated: Jan 28, 2026

BCBS TN Medical Policy Manual Specialty Medications Added: Blenrep, Inlexzo

5/22/2025 Added: Bizengri, Datroway, Niktimvo

1/20/2025 Added: Yimmugo, Zunovo

BCBS TN | Specialty Pharmacy | updated: Feb 1, 2026

BCBS TN Provider Administered Specialty Pharmacy Products 2026

BCBS AL | Medicare | Effective: Jan 20, 2026

BlueAdvantage Choice Formulary 2026

BCBS TN | Commercial | Effective: Feb 1, 2026

Essential Formulary Guide 2026

Harvard Pilgrim | Commercial | Effective: Apr 1, 2026

Harvard Pilgrim Health Tufts Medicare Preferred Prior Authorization, Notification, and No Prior Authorization Medical Necessity Guidelines 2026

Independent Health | Commercial | Effective: Jan 14, 2026

Independent Health Medicare Advantage Enhanced Part D Formulary PA Criteria 2026

Kaiser Permanente | Commercial | updated: Jan 30, 2026

Kaiser Permanente Employer Group Closed Future Formulary Changes 11/04/2024 Humira moves to T3

Kaiser Permanente | Commercial | Effective: Jan 30, 2026

Kaiser Permanente Formulary Changes

Kaiser Permanente | Medicare | updated: Jan 30, 2026

Kaiser Permanente Medicare Employer Group Open Plans Formulary Changes

Kaiser Permanente | Commercial | updated: Jan 30, 2026

Kaiser Permanente Open Future Formulary Changes 11/04/2024 Humira moves to T3

Molina | Commercial | Effective: Jan 1, 2026

Molina Healthcare NY Affinity Essential Formulary Updates

Molina | Commercial | Effective: Jan 1, 2026

Molina Healthcare NY Essential Formulary Updates 2026

Point32 Health | Commercial | Effective: Jan 1, 2026

Point32Health Pharmacy Coverage Formulary Updates 2026

Security Health Plan | ACA | Effective: Jan 22, 2026

Security Health Plan ACA Complete Formulary 2026

Univera | Medicare | updated: Jan 14, 2026

Univera Clinical Review Prior Authorization (CRPA) Medical

January 27, 2026

BCBS AL | Specialty Pharmacy | updated: Feb 2026

BCBS AL Provider-Administered and Precertification Drug List Added: Bomyntra, Conexxence, Denosumab, Jubbonti, Osenvelt, Ospomyv, Stoboclo, Wyost, Xbryk, Xgeva, 11/16/2025 Added: Elevidys, Imaavy

BCBS GA | Medicare | Effective: Jan 1, 2026

BCBS GA Specialty Drugs not Covered Under the Pharmacy 2026

BCBS RI | Policy | Effective: Apr 1, 2026

BCBS RI Draft Medical Policy Forms Updated

BCBS RI | Commercial | Effective: Jan 1, 2026

BCBS RI PA Guidelines and Forms Added: Anzupgo, Beizray, Rhapsido 2026

Capital BC | Exclusions | Effective: Jan 1, 2026

Capital BC Exclusive Full Formulary 2026

LA Care Health Plan | Medicare | Effective: Jan 2026

LA Care Health Plan Formulary Updates