2027 Express Scripts National Preferred Formulary

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DEXCOM G6: RECEIVER, SENSOR, TRANSMITTER DEXCOM G7: RECEIVER, SENSOR dexmethylphenidate dexmethylphenidate er dextroamphetamine/amphetamine dextroamphetamine/amphetamine er diazepam

ERIVEDGE* ERLEADA* erythromycin eye ointment ERZOFRI escitalopram tablets, solution esomeprazole magnesium dr ESPEROCT* estradiol cream, vaginal inserts estradiol patches estradiol tablets estradiol/norethindrone acetate eszopiclone

FRAGMIN* FREESTYLE KITS/METERS: FREESTYLE FREEDOM, FREESTYLE FREEDOM LITE, FREESTYLE INSULINX,FREESTYLE LITE FREESTYLE LIBRE: READER, SENSOR FREESTYLE TEST STRIPS: FREESTYLE, FREESTYLE INSULINX, FREESTYLE LITE, FREESTYLE PRECISION NEO FRUZAQLA*

diclofenac sodium dr diclofenac sodium er dicyclomine 10mg, 20mg digoxin DILANTIN 30MG diltiazem er capsules dimethyl fumarate* diphenoxylate/atropine

FULPHILA* furosemide FYCOMPA fyremadel*

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

G gabapentin GAMMACORE

divalproex dr divalproex er donepezil DOPTELET, DOPTELET SPRINKLE* dorzolamide/timolol drops DOVATO* doxazosin doxepin capsules, solution, tablets doxycycline hyclate capsules, tablets (except 80mg) doxycycline monohydrate DROPLET: LANCETS, GENTEEL LANCING DEVICE DUAVEE DULERA duloxetine dr 20mg, 30mg, 40mg, 60mg

GAVRETO* gemfibrozil GENOTROPIN* GENVOYA* GLASSIA* glatopa* glimepiride 1mg, 2mg, 4mg glipizide 5mg, 10mg glipizide er glucagon emergency kit (all manufacturers covered except Fresenius) glyburide GLYXAMBI GONAL-F, GONAL-F RFF REDI-JECT* H HAEGARDA* HARVONI* HERCESSI* HUMALOG CARTRIDGE, U-100 KWIKPEN, U-200 KWIKPEN, JUNIOR KWIKPEN HUMALOG MIX HUMULIN HUMULIN MIX hydralazine hydrochlorothiazide hydrocodone/acetaminophen hydrocodone/chlorpheniramine polistirex er hydrocortisone topical hydromorphone hydroxychloroquine hydroxyzine hcl hydroxyzine pamoate GRASTEK guanfacine guanfacine er GVOKE

EUCRISA EYSUVIS ezetimibe ezetimibe/simvastatin

F FABHALTA* FABRAZYME*

DUPIXENT* DYSPORT*

famotidine FASENRA* fenofibrate capsules (43mg, 67mg, 134mg, 200mg) fenofibrate tablets (48mg, 54mg, 145mg, 160mg) fenofibric acid dr FENSOLVI* fentanyl patches FETZIMA FILSPARI* FINACEA FOAM

E EBGLYSS* eletriptan ELFABRIO* ELIQUIS, ELIQUIS SPRINKLE ELOCTATE* EMBECTA PEN NEEDLES EMBECTA SYRINGES

EMGALITY EMPAVELI* emtricitabine/tenofovir disoproxil fumarate* EMVERM enalapril ENBREL* ENDOMETRIN* enoxaparin* ENSACOVE* ENSTILAR ENTYVIO IV* EPCLUSA* EPIDIOLEX* epinephrine auto-injector (by Mylan, Teva) EPYSQLI* ergocalciferol

finasteride fingolimod* flecainide

FLECTOR fluconazole fluocinolone fluocinonide fluoxetine fluticasone nasal fluticasone/salmeterol inhalation powder fluvoxamine

HYMPAVZI* hyoscyamine

fluvoxamine er folic acid tablets FOUNDAYO

© 2026 Evernorth Health Services. All rights reserved. All trademarks are the property of their respective owners. CRP1678902 #1702 NP (08/01/2026)

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