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2026 Formulary Changes

The table below outlines all the changes to our formulary since the formulary list was last printed on 07/01/2026.

Drug NameDescription of Change*Copay AmountEffective Date
of Change
Hernexeos (zongertinib)Addition to formulary with PA$104/01/2026
Modeyso (dordaviprone)Addition to formulary with PA$104/01/2026
Ensacove (ensartinib)Addition to formulary with PA$104/01/2026
Ibtrozi (taletrectinib)Addition to formulary with PA$104/01/2026
Novolog Mix 70/30 vial, and Novologix Mix FlexPenAddition to formulary with PA$104/01/2026
Inluriyo (imlunestrant) Addition to formulary with PA$107/01/2026
Komzifti (ziftomenib)Addition to formulary with PA$107/01/2026
Hyrnuo (sevabertinib)Addition to formulary with PA$107/01/2026
Fiasp (insulin aspart) 100-unit vial and FlexTouchAddition to formulary with QL$107/01/2026
umeclidinium-vilanterol (generic of Anoro Ellipta)ST removal$107/01/2026
lubiprostone (generic Amitiza)PA removal; Addition of QL$107/01/2026

*QL = Quantity Limit, PA = Prior Authorization, ST = Step Therapy, NF = Non Formulary, N/A = Not Applicable

All documents are available in paper form without charge. To request a paper copy, please call Customer Service at:

Monday through Friday, 8 a.m. to 5 p.m.

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