From time to time, we add or remove drugs from the approved drug list (formulary). We also may change their tier, which determines how much you pay for them. We make these changes based on the scientific evidence we have of their value in helping people get well and stay healthy.
If you are taking a drug that is being removed
If we remove drugs from the formulary during the year, we'll notify you of the change at least 30 days before the date that the change becomes effective. The exceptions to this 30-day notice are when the FDA decides a drug is not safe, or if a drug manufacturer removes the drug from the market.
We may also immediately remove a brand name drug if we are replacing it with a new generic drug that will appear on the same or lower cost sharing tier and with the same or fewer restrictions. If you are currently taking that brand name drug, we may not tell you in advance before we make that change, but we will later provider you with information about the specific change(s) we have made.
You may ask Priority Health to make an exception for you so you can continue taking a drug that's removed from the formulary. We must make a decision within 72 hours of your request. Contact Customer Service to make these requests.
Learn more about asking for an exception.
Current and pending changes to the 2026 approved drug list
- Jump down to Changes/removals from the approved drug list
KEY:
- ALL CAPS = Brand names
- Lower case = Generic
- B/D = Coverage varies under Medicare Part B (medical) vs. Part D (prescription) benefits
- HI = Home infusion drug
- LA = Limited availability (available only at certain pharmacies)
- PA = Prior authorization from Priority Health is required
- QL = Quantity limits apply
- ST = Step therapy, trying other drugs first is required
Additions effective Mar. 1, 2026 | |||
| Drug Name | Tier | Category: Class | Notes |
|---|---|---|---|
| BILDYOS® PREFILLED SYRINGE 60 MG/ML | 4 | Metabolic Bone Disease Agents: Metabolic Bone Disease Agents | QL (1 ML per 180 days) |
| ciprofloxacin-hydrocortisone suspension 0.2-1% otic | 4 | Otic Agents: Otic Agents | |
| ceftaroline fosamil vial 400 mg, 600 mg | 4 | Antibacterials: Beta-Lactam, Cephalosporins | |
| KOMZIFTI™ CAPSULE 200 MG | 5 | Antineoplastics: Molecular Target Inhibitors | PA, QL (90 EA per 30 days) |
| REDEMPLO® SYRINGE 25 MG/0.5 ML | 5 | Cardiovascular Agents: Cardiovascular Agents: Other | PA, QL (0.5 ML per 84 days) |
| SHINGRIX SYRINGE 50 MCG/0.5 ML | 3 | Immunological Agents: Vaccines | QL (1 ML per 999 days) |
Additions effective Feb. 1, 2026 | |||
| Drug Name | Tier | Category: Class | Notes |
|---|---|---|---|
| BILPREVDA® VIAL 120 MG/1.7 ML | 5 | Metabolic Bone Disease Agents: Metabolic Bone Disease Agents | PA |
| INLURIYO™ TABLET 200 MG | 5 | Antineoplastics: Antiestrogens/Modifiers | PA, QL (84 EA per 28 days) |
| nilotinib hcl capsule | 5 | Antineoplastics: Molecular Target Inhibitors | PA, QL (120 EA per 30 days) |
| nortrel® 0.5/35 (28) tablet 0.5-35 mg-mcg | 4 | Hormonal Agents, Stimulant/Replacement/Modifying (Sex Hormones/Modifiers): Progestins | |
| perampanel oral suspension 0.5 mg/ml | 5 | Anticonvulsants: Anticonvulsants, Other | PA, QL (680 ML per 28 days) |
| TYMLOS® SOLUTION PEN-INJECTOR 3120 MCG/1.56ML | 5 | Metabolic Bone Disease Agents: Metabolic Bone Disease Agents | PA, QL (1.56 ML per 30 days) |
| VRAYLAR CAPSULE 0.5 MG, 0.75 MG | 5 | Antipsychotics: 2nd Generation, Atypical | PA, QL (30 EA per 30 days) |
| XPOVIO® (80 MG ONCE WEEKLY) TABLET THERAPY PACK | 5 | Antineoplastics: Antineoplastics, Other | PA, QL (4 EA per 28 days) |
Changes/removals from the approved drug list
Changes/removals effective Mar. 1, 2026 | ||
| Drug Name | Tier | Notes |
|---|---|---|
| doxycycline hyclate intravenous solution reconstituted 100 mg | 4 | Removed Part B vs. Part D PA |
| neo-polycin hc ophthalmic ointment 1 % | 2 | Removed from formulary; no longer Part D eligible |
| neo-polycin ophthalmic ointment 3.5-400-10000 | 2 | Removed from formulary; no longer Part D eligible |
| NORDITROPIN® FLEXPRO® SUBCUTANEOUS SOLUTION PEN-INJECTOR 30 MG/3ML | 5 | Removed from CMS's reference file; removed from formulary - discontinued by manufacturer |
| polycin ophthalmic ointment 500-10000 unit/gm | 2 | Removed from formulary; no longer Part D eligible |
| STELARA® SUBCUTANEOUS SOLUTION 45 MG/0.5ML VIAL | 5 | Removed original biologic product from formulary; biosimilar added |
| sulfacetamide sodium ophthalmic ointment 10 % | 2 | Removed from CMS's reference file; removed from formulary |
| ustekinumab subcutaneous solution 45 mg/0.5ml vial | 5 | Removed biologic product from formulary; biosimilar added |
| VYNDAQEL® ORAL CAPSULE 20 MG | 5 | Removed from CMS's reference file; removed from formulary - discontinued by manufacturer |
Changes/removals effective Feb. 1, 2026 | ||
| Drug Name | Tier | Notes |
|---|---|---|
| BRUKINSA® CAPSULE 80 MG | 5 | Removed from CMS's reference file; removed from formulary - discontinued by manufacturer |
| GLEOSTINE® CAPSULE 10 MG, 40 MG | 4 | Removed brand from formulary; generic added |
| GLEOSTINE® CAPSULE 100 MG | 5 | Removed brand from formulary; generic added |
| junel® 1/20 tablet 1-20 mcg-mcg | 2 | Lowered tier |
| OCALIVA® ORAL TABLET | 5 | Removed from the market; removed from formulary |
| sumatriptan succinate refill subcutaneous solution cartridge 6 mg/0.5ml | 4 | Removed from CMS's reference file; removed from formulary |
| sumatriptan succinate subcutaneous solution auto-injector 4 mg/0.5ml | 4 | Removed from CMS's reference file; removed from formulary |
| TASIGNA® CAPSULE | 5 | Removed brand from formulary; generic added |