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)
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.
© 2026 Evernorth Health Services. All rights reserved. All trademarks are the property of their respective owners.
CRP1678902 #1702 NP-A PRMT22157-26 (07/01/2026)
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