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 EXKIVITY [SP] famotidine FARXIGA FASENRA [INJ] [SP] fenofibrate 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 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] EYSUVIS ezetimibe ezetimibe/simvastatin F FABHALTA [SP] FABRAZYME [INJ] [SP] FLECTOR fluconazole fluocinolone fluocinonide fluoxetine
GLASSIA [INJ] [SP] glatopa [INJ] [SP] glimepiride glipizide glipizide ext-release glucagon emergency kit [INJ] glyburide GLYXAMBI GONAL-F, GONAL-F RFF, 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] HYSINGLA ER I ibandronate IBRANCE [SP] ibuprofen icosapent ethyl IDELVION [INJ] [SP] ILET: PUMP, SUPPLIES IMBRUVICA [SP] IMKELDI [SP] INBRIJA [SP] INCRUSE ELLIPTA indomethacin INFLIXIMAB [INJ] [SP] INGREZZA, INGREZZA SPRINKLE [SP] INLYTA [SP] INSULIN GLARGINE-YFGN [INJ] INSULIN LISPRO [INJ] INSULIN LISPRO PROTAMINE MIX [INJ] ipratropium bromide nasal spray ipratropium/albuterol sulfate nebulization solution IQIRVO [SP] irbesartan isosorbide mononitrate ext-release isotretinoin J JAKAFI [SP] JANUMET, JANUMET XR JANUVIA
JARDIANCE JIVI [INJ] [SP] JULUCA [SP] K KERENDIA
methylprednisolone metoclopramide metoprolol succinate ext-release metoprolol tartrate metronidazole 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 MULTAQ mupirocin MYFEMBREE MYHIBBIN [SP] MYRBETRIQ N nabumetone naloxone nasal spray NAMZARIC naproxen naproxen sodium NASCOBAL NAYZILAM nebivolol NEFFY NEMLUVIO [INJ] [SP] neomycin/polymyxin/hydrocortisone ear solution 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 NURTEC ODT nystatin nystatin topical O OCALIVA [SP] OCREVUS, OCREVUS ZUNOVO [INJ] [SP] ODACTRA NEXLETOL NEXLIZET
KESIMPTA [INJ] [SP] ketoconazole topical ketorolac KISQALI [SP] KITABIS PAK [SP] KLOXXADO KOVALTRY [INJ] [SP] KYLEENA [SP] L labetalol lacosamide LAGEVRIO (EUA) lamotrigine lansoprazole delayed-release latanoprost eye solution LENVIMA [SP] letrozole
levetiracetam levocetirizine levofloxacin levothyroxine sodium levoxyl LICART lidocaine patches LINZESS liothyronine liraglutide [INJ] lisdexamfetamine lisinopril lisinopril/hctz lithium carbonate LIVDELZI [SP]
LOKELMA lorazepam LORBRENA [SP] losartan losartan/hctz loteprednol eye suspension lovastatin LUMRYZ ER [SP] LUPKYNIS [SP] LUPRON DEPOT [INJ] [SP] lurasidone LYNPARZA [SP] LYUMJEV [INJ] LYUMJEV TEMPO [INJ] M magnesium sulfate/potassium sulfate/sodium sulfate solution MAYZENT [SP] meclizine medroxyprogesterone MEKINIST [SP] MEKTOVI [SP] meloxicam mesalamine delayed-release metaxalone metformin metformin ext-release methimazole methocarbamol methotrexate methylphenidate methylphenidate ext-release
furosemide FYCOMPA fyremadel [INJ] [SP] G gabapentin GAMMACORE GAVRETO [SP] GELNIQUE gemfibrozil GENOTROPIN [INJ] [SP] GENVOYA [SP]
ODEFSEY [SP] ODOMZO [SP] OFEV [SP]
(continued) Go to express-scripts.com/2026drugs for a full list of formulary exclusions with their covered alternatives or log on to compare drug 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. For Stelara, see Exclusion Document for more information.
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CRP1476501 #1702 NP-A PRMT22157-26 (08/08/2025)
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