Express Scripts National Preferred Formulary

The following is a list of the most commonly prescribed medications covered on the National Preferred Formulary prescription drug list (PDL). It represents an abbreviated version of the PDL that is at the core of your prescription plan. The PDL is not all-inclusive and does not guarantee coverage. In addition to using this PDL, you are encouraged to ask your physician to prescribe generic medications whenever appropriate. PLEASE NOTE: Brand-name medications may move to nonformulary status if a generic equivalent version becomes available during the plan year. Not all the medications listed are covered by all prescription plans; check your benefit materials for the specific medications covered and the copays for your prescription plan. For specific questions about your coverage, please call the phone number printed on your prescription ID card.

2026 Express Scripts National Preferred Formulary

KEY [INJ] - Injectable Medication [OTC] - Over-the-Counter Product [SP] - Specialty Medication Brand-name medications are listed in CAPITAL letters. Generic medications are listed in lower case letters. A ABILIFY ASIMTUFII [INJ] ABILIFY MAINTENA [INJ] ACCU-CHEK: FASTCLIX, SOFTCLIX LANCETS [OTC] acetaminophen/codeine acyclovir ADALIMUMAB-ADAZ [INJ] [SP] ADALIMUMAB-ADBM (by Boehringer Ingelheim & Quallent) [INJ] [SP] ADBRY [INJ] [SP] ADEMPAS [SP] ADVAIR HFA ADVATE [INJ] [SP] ADYNOVATE [INJ] [SP] AFSTYLA [INJ] [SP] AIMOVIG [INJ] AIRSUPRA AJOVY [INJ] albuterol nebulization solution albuterol sulfate hfa (all manufacturers covered except Prasco) ALECENSA [SP] alendronate alfuzosin ext-release ALHEMO PEN [INJ] [SP]

ARMOUR THYROID ASMANEX HFA ASMANEX TWISTHALER atenolol

carbidopa/levodopa carvedilol cefdinir cefuroxime axetil celecoxib cephalexin CEQUR SIMPLICITY CERDELGA [SP] CEREZYME [INJ] [SP] CETROTIDE [INJ] [SP] chlorhexidine gluconate chlorthalidone CIBINQO [SP] CIMDUO [SP] CIMERLI [INJ] [SP] CINRYZE [INJ] [SP] ciprofloxacin citalopram

dextroamphetamine/amphetamine ext-release diazepam diclofenac sodium delayed-release dicyclomine 10mg, 20mg digoxin DILANTIN 30MG diltiazem ext-release dimethyl fumarate [SP] diphenoxylate/atropine divalproex delayed-release divalproex ext-release donepezil DOPTELET, DOPTELET SPRINKLE [SP] dorzolamide/timolol eye solution DOVATO [SP] doxazosin doxepin capsules, solution, tablets doxycycline hyclate capsules, tablets (except 80mg) doxycycline monohydrate DROPLET: LANCETS, GENTEEL LANCING DEVICE [OTC] DUAVEE DULERA duloxetine delayed-release DUPIXENT [INJ] [SP] DYSPORT [INJ] [SP] E EBGLYSS [INJ] [SP] eletriptan ELFABRIO [INJ] [SP] ELIQUIS, ELIQUIS SPRINKLE ELOCTATE [INJ] [SP] EMBECTA PEN NEEDLES [OTC] EMBECTA SYRINGES [OTC] EMGALITY [INJ]

atomoxetine atorvastatin AUGTYRO [SP] AUVI-Q [INJ]

AVONEX [INJ] [SP] AVSOLA [INJ] [SP] AVTOZMA IV [INJ] [SP] AZASITE azathioprine [SP] azelaic acid azelastine nasal spray azithromycin AZSTARYS B baclofen BAFIERTAM [SP] BAQSIMI BARACLUDE SOLUTION BAXDELA BAXDELA [INJ] BELBUCA benazepril BENEFIX [INJ] [SP] benzonatate betamethasone dipropionate BETASERON [INJ] [SP] BIKTARVY [SP] BILDYOS [INJ] [SP] BILPREVDA [INJ] [SP]

clarithromycin clindamycin hcl clindamycin phosphate topical clindamycin phosphate/ benzoyl peroxide clobetasol propionate 0.05% topical clomiphene citrate clonazepam clonidine hcl tablets (except 0.05mg) clopidogrel clotrimazole/betamethasone dipropionate colchicine COMBIPATCH COMBIVENT RESPIMAT COTELLIC [SP] CREON CRINONE 8% [SP] cyanocobalamin [INJ] cyclobenzaprine cyclosporine eye solution D DANZITEN [SP] dapagliflozin dapagliflozin/metformin ext-release dasatinib [SP] deferiprone [SP] DELSTRIGO [SP] DESCOVY [SP] desloratadine tablets desonide desvenlafaxine succinate ext-release dexamethasone DEXCOM G6: RECEIVER, SENSOR, TRANSMITTER DEXCOM G7: RECEIVER, SENSOR dexmethylphenidate ext-release dextroamphetamine/amphetamine

bisoprolol/hctz BOSULIF [SP] BRAFTOVI [SP] BREO ELLIPTA

allopurinol alprazolam

BREZTRI AEROSPHERE brimonidine eye solution BRINSUPRI [SP] BRIXADI [INJ] [SP] BRUKINSA [SP] budesonide nebulization suspension budesonide/formoterol inhaler buprenorphine/naloxone bupropion bupropion ext-release 150mg, 300mg buspirone butalbital/acetaminophen/caffeine BYOOVIZ [INJ] [SP] C CABENUVA [INJ] [SP]

ALPROLIX [INJ] [SP] ALTUVIIIO [INJ] [SP] ALUNBRIG [SP] ALYFTREK [SP]

EMPAVELI [INJ] [SP] emtricitabine/tenofovir

disoproxil fumarate [SP]

EMVERM enalapril

amiodarone amitriptyline amlodipine

ENBREL [INJ] [SP] ENDOMETRIN [SP] enoxaparin [INJ] [SP] ENSACOVE [SP] ENSTILAR ENTYVIO IV [INJ] [SP] EPCLUSA [SP] EPIDIOLEX [SP] epinephrine auto-injector (by Mylan, Teva) [INJ] EPYSQLI [INJ] [SP] ergocalciferol ERIVEDGE [SP] ERLEADA [SP] erythromycin eye ointment ERZOFRI [INJ]

amlodipine/benazepril amlodipine/valsartan amoxicillin amoxicillin/potassium clavulanate anastrozole ANDEMBRY AUTOINJECTOR [INJ] [SP] ANORO ELLIPTA ANZUPGO [SP] APRETUDE [INJ] [SP] ARALAST NP [INJ] [SP] ARIKAYCE [SP] aripiprazole ARISTADA, ARISTADA INITIO [INJ]

CABOMETYX [SP] CALQUENCE [SP] CAMZYOS [SP] CARBAGLU [SP]

(continued)

Go to express-scripts.com/2026drugs for a full list of prescription drug list exclusions with their covered alternatives or log on to compare medication prices. Costs for covered alternatives may vary. THIS DOCUMENT LIST IS EFFECTIVE JANUARY 1, 2026, THROUGH DECEMBER 31, 2026. THIS LIST IS SUBJECT TO CHANGE. You can find more information at express-scripts.com.

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G gabapentin

escitalopram tablets, solution esomeprazole magnesium delayed-release ESPEROCT [INJ] [SP] estradiol estradiol cream, vaginal inserts estradiol patches estradiol/norethindrone acetate eszopiclone ethinyl estradiol/desogestrel ethinyl estradiol/drospirenone ethinyl estradiol/drospirenone/ levomefolate ethinyl estradiol/ethynodiol ethinyl estradiol/etonogestrel vaginal ring ethinyl estradiol/levonorgestrel ethinyl estradiol/levonorgestrel/iron ethinyl estradiol/ norelgestromin patches ethinyl estradiol/norethindrone ethinyl estradiol/ norethindrone acetate ethinyl estradiol/norethindrone/iron ethinyl estradiol/norgestimate ethinyl estradiol/norgestrel EUCRISA EYSUVIS ezetimibe ezetimibe/simvastatin F FABHALTA [SP] FABRAZYME [INJ] [SP] famotidine FASENRA [INJ] [SP] fenofibrate capsules (except 50mg, 150mg), tablets fenofibric acid delayed-release FENSOLVI [INJ] [SP] fentanyl patches FETZIMA FILSPARI [SP] FINACEA FOAM finasteride fingolimod [SP] fluticasone nasal spray fluticasone/salmeterol inhalation powder folic acid tablets FOUNDAYO FRAGMIN [INJ] [SP] FREESTYLE KITS/METERS: FREESTYLE FREEDOM, FREESTYLE FREEDOM LITE, FREESTYLE INSULINX, FREESTYLE LITE [OTC] FREESTYLE LIBRE: READER, SENSOR FREESTYLE TEST STRIPS: FREESTYLE, FREESTYLE INSULINX, FREESTYLE LITE, FREESTYLE PRECISION NEO [OTC] FRUZAQLA [SP] FULPHILA [INJ] [SP] FLECTOR fluconazole fluocinolone fluocinonide fluoxetine

ipratropium/albuterol sulfate nebulization solution IQIRVO [SP] irbesartan isosorbide mononitrate ext-release isotretinoin J

MEKTOVI [SP] meloxicam capsules, tablets MERILOG [INJ] mesalamine delayed-release metaxalone 400mg, 800mg metformin 500mg, 750mg, 850mg, 1000mg metformin ext-release methimazole methocarbamol 500mg, 750mg methotrexate methylphenidate methylphenidate ext-release capsules, tablets (except 45mg, 63mg) methylprednisolone metoclopramide metoprolol succinate ext-release metoprolol tartrate (except 12.5mg) metronidazole 250mg, 500mg tablets metronidazole topical metronidazole vaginal MICROLET: LANCETS, NEXT LANCING DEVICE [OTC] MIEBO MINIMED: INSULIN PUMP, PUMP INFUSION SETS, PARADIGM RESERVOIR minocycline mirabegron ext-release MIRENA [SP] mirtazapine MIRVASO MITIGARE modafinil mometasone MONOVISC [INJ] [SP] montelukast morphine sulfate ext-release MOUNJARO [INJ] MOVANTIK moxifloxacin eye solution

GAMMACORE GAVRETO [SP] gemfibrozil GENOTROPIN [INJ] [SP] GENVOYA [SP] GLASSIA [INJ] [SP] glatopa [INJ] [SP] glimepiride 1mg, 2mg, 4mg glipizide 5mg, 10mg glipizide ext-release glucagon emergency kit (all manufacturers covered except Fresenius) [INJ] glyburide GLYXAMBI GONAL-F, GONAL-F RFF REDI-JECT [INJ] [SP] GRASTEK guanfacine ext-release GVOKE [INJ] H HAEGARDA [INJ] [SP] HARVONI [SP] HEMANGEOL [SP] HERCESSI [INJ] [SP] HUMALOG CARTRIDGE, U-100 KWIKPEN, U-200 KWIKPEN, JUNIOR KWIKPEN [INJ] HUMALOG MIX [INJ] HUMALOG TEMPO [INJ] HUMULIN [INJ] HUMULIN MIX [INJ] hydralazine hydrochlorothiazide hydrocodone/acetaminophen hydrocodone/chlorpheniramine polistirex ext-release hydrocortisone topical hydromorphone hydroxychloroquine hydroxyzine hcl hydroxyzine pamoate HYMPAVZI PEN [INJ] [SP] I ibandronate ICLUSIG [SP] icosapent ethyl ICOTYDE [SP] IDELVION [INJ] [SP] ILET: PUMP, SUPPLIES IMKELDI [SP] IMULDOSA [INJ] [SP] INBRIJA [SP] INCRUSE ELLIPTA indomethacin INFLIXIMAB [INJ] [SP] INGREZZA, INGREZZA SPRINKLE [SP] INLYTA [SP] INSULIN GLARGINE-YFGN (by Biocon) [INJ] INSULIN LISPRO [INJ] INSULIN LISPRO PROTAMINE MIX [INJ] INVEGA HAFYERA [INJ] INVEGA SUSTENNA [INJ] INVEGA TRINZA [INJ] ipratropium bromide nasal spray IBRANCE [SP] IBTROZI [SP] ibuprofen

JAKAFI, JAKAFI XR [SP] JANUMET, JANUMET XR JANUVIA JARDIANCE

JASCAYD [SP] JIVI [INJ] [SP] JULUCA [SP] K KERENDIA

KESIMPTA [INJ] [SP] ketoconazole topical ketorolac KISQALI [SP] KITABIS PAK [SP] KLOXXADO KOVALTRY [INJ] [SP] KYLEENA [SP] L labetalol 100mg, 200mg, 300mg lacosamide LAGEVRIO (EUA) lamotrigine chewable dispersible tablets, tablets lansoprazole delayed-release LANTUS [INJ] latanoprost eye solution LENVIMA [SP] letrozole levetiracetam solution, tablets levocetirizine levofloxacin levothyroxine tablets levoxyl LICART lidocaine patches LINZESS liothyronine liraglutide [INJ] lisdexamfetamine lisinopril lisinopril/hctz lithium carbonate LOKELMA lorazepam LORBRENA [SP] losartan losartan/hctz loteprednol eye suspension lovastatin LUMRYZ ER [SP] LUPKYNIS [SP] LUPRON DEPOT [INJ] [SP] lurasidone

MULTAQ mupirocin MYFEMBREE MYHIBBIN [SP] MYQORZO [SP] MYRBETRIQ N

nabumetone NAMZARIC naproxen naproxen sodium NASCOBAL NAYZILAM nebivolol NEFFY NEMLUVIO [INJ] [SP] neomycin/polymyxin/hydrocortisone ear solution

NEXLETOL NEXLIZET

NGENLA [INJ] [SP] niacin ext-release nifedipine ext-release NINLARO [SP] nitrofurantoin macrocrystal NITYR [SP] NIVESTYM [INJ] [SP] norethindrone nortriptyline NOVOEIGHT [INJ] [SP] NUBEQA [SP] NUCALA [INJ] [SP] NUEDEXTA

LYNPARZA [SP] LYUMJEV [INJ] LYUMJEV TEMPO [INJ] M

magnesium sulfate/potassium sulfate/sodium sulfate solution MAYZENT [SP] meclizine 12.5mg, 25mg medroxyprogesterone MEKINIST [SP]

furosemide FYCOMPA fyremadel [INJ] [SP]

(continued)

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Q quetiapine (except 150mg) QULIPTA QVAR REDIHALER R rabeprazole delayed-release tablets RADICAVA ORS [SP] RAGWITEK raloxifene ramipril REBIF [INJ] [SP] RECTIV RELISTOR [INJ] REPATHA [INJ] RESTASIS MULTIDOSE RETACRIT [INJ] [SP] REZDIFFRA [SP] RHAPSIDO RINVOQ ER, RINVOQ LQ [SP] risperidone RUCONEST [INJ] [SP] RUXIENCE [INJ] [SP] RYBELSUS RYDAPT [SP] RYKINDO [INJ] S SCEMBLIX [SP] SELARSDI [INJ] [SP] SEMGLEE (YFGN) [INJ] sertraline SEVENFACT [INJ] [SP] sildenafil SIMLANDI [INJ] [SP] SIMPONI 100MG (for Ulcerative Colitis only) [INJ] [SP] rizatriptan roflumilast ropinirole rosuvastatin ROZLYTREK [SP] SKYRIZI [INJ] [SP] sodium oxybate [SP] solifenacin SOLIQUA [INJ] SOLOSEC SOMATULINE DEPOT [INJ] [SP] SOMAVERT [INJ] [SP] SOTYKTU [SP] SPIRIVA RESPIMAT spironolactone SPRAVATO [SP] STIOLTO RESPIMAT STIVARGA [SP] STRENSIQ [INJ] [SP] STRIVERDI RESPIMAT SUBLOCADE [INJ] [SP] sucralfate sulfamethoxazole/trimethoprim sumatriptan SUNOSI SUPPRELIN LA [SP] SYMFI [SP] SYMPROIC SYMTUZA [SP] SYNJARDY, SYNJARDY XR T simvastatin SKYLA [SP]

NURTEC ODT nystatin nystatin topical O OCREVUS, OCREVUS ZUNOVO [INJ] [SP] ODACTRA olanzapine olmesartan olmesartan/hctz omega-3 acid ethyl esters omeprazole delayed-release OMNIPOD 5: KITS, PODS OMNIPOD DASH: KITS, PODS OMNITROPE [INJ] [SP] OMVOH [INJ] [SP] ondansetron odt 4mg, 8mg tablets ondansetron solution, tablets ODEFSEY [SP] ODOMZO [SP] ofloxacin OGIVRI [INJ] [SP] ORIAHNN ORILISSA ORTHOVISC [INJ] [SP] oseltamivir OTEZLA, OTEZLA XR [SP] OVIDREL [INJ] [SP] oxcarbazepine oxybutynin ext-release oxycodone capsules, uncoated tablets oxycodone/acetaminophen OZEMPIC [INJ] OZEMPIC TABLETS P PANCREAZE pantoprazole delayed-release paroxetine hcl PAXLOVID penicillin v potassium PENTASA 250MG CAPSULES pioglitazone PIQRAY [SP] PLEGRIDY [INJ] [SP] polymyxin/trimethoprim eye solution potassium chloride ext-release pramipexole pravastatin PRECISION XTRA: PHEBURANE [SP] PHESGO [INJ] [SP] PIFELTRO [SP] METERS, TEST STRIPS, B-KETONE STRIPS [OTC] prednisolone acetate eye suspension prednisolone sodium phosphate OPSUMIT [SP] OPSYNVI [SP] ORALAIR [SP]

TAFINLAR [SP] TAGRISSO [SP] TAKHZYRO [INJ] [SP] TALICIA

VARUBI VASCEPA VELSIPITY [SP] VELTASSA VEMLIDY venlafaxine

TALTZ [INJ] [SP] TALZENNA [SP] tamoxifen tamsulosin ext-release TANDEM MOBI CARTRIDGE, KIT, SYSTEM TANDEM T:SLIM CARTRIDGE, KIT TAVALISSE [SP] TECHLITE LANCETS [OTC] telmisartan terazosin terconazole vaginal teriflunomide [SP] teriparatide [INJ] [SP] testosterone cypionate [INJ] TEZSPIRE [INJ] [SP] thyroid pork (except 16.25mg, 32.5mg, 65mg, 97.5mg, 130mg) timolol maleate eye solution tiotropium powder inhaler tizanidine tablets TOBI PODHALER [SP] tobramycin eye solution tobramycin/dexamethasone eye suspension topiramate ext-release topiramate tablets torsemide TOUJEO [INJ] tramadol 50mg, 100mg trazodone TRELEGY ELLIPTA TREMFYA [INJ] [SP] treprostinil [INJ] [SP] TRESIBA [INJ] tretinoin topical triamcinolone topical triamterene/hctz TRIJARDY XR TRIPTODUR [INJ] [SP] TRIUMEQ [SP] TRIVIDIA METERS: TRUE METRIX AIR, TRUE METRIX, TRUE METRIX GO [OTC] TRIVIDIA TEST STRIPS: TRUE METRIX [OTC] TRUEPLUS LANCETS [OTC] TRULANCE TRULICITY [INJ]

venlafaxine ext-release verapamil ext-release VERQUVO VERZENIO [SP] VGO VIBERZI vilazodone VIOKACE VITRAKVI [SP] VIVITROL [INJ] [SP] VIZIMPRO [SP] VOSEVI [SP] VOYDEYA [SP] VOYXACT [INJ] [SP] VTAMA VUMERITY [SP] VYNDAMAX [SP] VYNDAQEL [SP] W warfarin WEGOVY HD [INJ]

WEGOVY PENS [INJ] WEGOVY TABLETS X XACIATO XALKORI [SP] XARELTO XDEMVY [SP] XELJANZ, XELJANZ SOLUTION, XELJANZ XR [SP] XHANCE XIFAXAN XIIDRA XOLAIR [INJ] [SP] XTANDI [SP] XYNTHA, XYNTHA SOLOFUSE [INJ] [SP] XYOSTED [INJ] XYWAV [SP] Y

YESINTEK [INJ] [SP] YEZTUGO [INJ] [SP] YEZTUGO [SP] YONSA [SP] YUPELRI YUTREPIA [SP] Z ZELBORAF [SP] ZEMAIRA [INJ] [SP] ZENPEP ZEPATIER [SP] ZEPBOUND PEN [INJ] ZEPOSIA [SP] ZIEXTENZO [INJ] [SP]

TRUQAP [SP] TWIIST: KITS

TYENNE [INJ] [SP] TYMLOS [INJ] [SP] TYRUKO [INJ] [SP] TYSABRI [INJ] [SP] TYVASO, TYVASO DPI [SP] U UBRELVY UPTRAVI TABLETS [SP] USTEKINUMAB-TTWE (by Quallent) [INJ] [SP] UZEDY [INJ] V valacyclovir valsartan tablets valsartan/hctz VALTOCO VANRAFIA [SP] varenicline

prednisone pregabalin

PREGNYL [INJ] [SP] PREMARIN CREAM prenatal vitamins PROCRIT [INJ] [SP]

ZIRABEV [INJ] [SP] zolpidem ext-release zolpidem tablets, sl tablets ZOMIG 2.5MG NASAL ZORYVE 0.05%, 0.15% CREAM ZTLIDO ZUBSOLV ZURZUVAE [SP] ZYKADIA [SP] ZYMFENTRA [INJ] [SP]

progesterone micronized PROLASTIN C [INJ] [SP] promethazine promethazine/dextromethorphan propranolol propranolol ext-release

TABRECTA [SP] tacrolimus topical tadalafil

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