To support drug access and affordability for our members, we’re making some changes to our medical and pharmacy drug coverage.
Pharmacy drug coverage changes
The below coverage changes are for brand/generic drugs designated as interchangeable at pharmacies. Because of their interchangeability status, no action is needed from providers and members won’t be notified of these changes.
- Adderall XR®
- Adderall XR will be removed from pharmacy drug coverage effective Mar. 1, 2026, for commercial members
- The Adderall generic, amphetamine/dextroamphetamine, remains on commercial formulary at Tier 1
- Conjugated estrogen tablets
- Conjugated estrogen tablets will be removed from pharmacy drug coverage effective Mar. 1, 2026, for commercial members
- Premarin® tablets (brand version) remain on commercial formulary at Tier 2
- Methylphenidate transdermal patches
- Methylphenidate transdermal patches will be removed from pharmacy drug coverage effective Mar. 1, 2026, for commercial members
- Daytrana® (brand version) will be added to pharmacy drug coverage at Tier 2 effective Mar. 1, 2026, for commercial members
The following drugs will be removed from commercial formulary beginning Mar. 1, 2026 and have a member impact of fewer than ten people:
- EstroGel® (generic covered at Tier 2, impacts 6 members)
- Lipitor®* (generic covered at Tier 1, impacts 3 members)
- Tryngolza (formulary alternative, Redemplo®, will be added to coverage, impacts 0 members)
Medical drug coverage changes
Gammagard S/D (J1566)
- Step therapy requirements, including trials of two preferred Intravenous immune globulin (IVIG) products (e.g., Gammagard Liquid, Gamunex-C, Privigen), will be added to Gammagard S/D medical drug coverage effective Apr. 1, 2026, for Medicare members
- This change only impacts members new to Gammagard S/D. For members with authorizations already on file, no action is needed
Axtle™ (J9292)
- Step therapy requirements, including a trial of pemetrexed (generic), will be added to Axtle under the medical benefit effective Apr. 1, 2026, for Medicare members
- This change only impacts members new to Axtle. For members currently being treated, no action is needed
You can find drug coverage information, including our Approved Drug Lists and our Medical Drug Lists, on the Drug Information page.