R rabeprazole delayed-release RADICAVA ORS [SP] RAGWITEK raloxifene ramipril REBIF [INJ] [SP] RECTIV RELISTOR [INJ] REPATHA [INJ] RESTASIS MULTIDOSE RETACRIT [INJ] [SP] REZDIFFRA [SP] RINVOQ ER, RINVOQ LQ [SP] risperidone RUCONEST [INJ] [SP] RUXIENCE [INJ] [SP] RYBELSUS RYDAPT [SP] RYKINDO [INJ] S SAVELLA 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] simvastatin SKYLA [SP] SKYRIZI [INJ] [SP] SODIUM OXYBATE (by Hikma) [SP] solifenacin SOLIQUA [INJ] SOLOSEC SOMATULINE DEPOT [INJ] [SP] SOMAVERT [INJ] [SP] SOTYKTU [SP] SPIRIVA RESPIMAT spironolactone STIOLTO RESPIMAT STIVARGA [SP] STRENSIQ [INJ] [SP] STRIVERDI RESPIMAT SUBLOCADE [INJ] [SP] sucralfate sulfamethoxazole/trimethoprim sumatriptan SUNOSI SUPPRELIN LA [SP] SYMFI, SYMFI LO [SP] SYMJEPI [INJ] SYMLINPEN [INJ] SYMPROIC SYMTUZA [SP] SYNJARDY, SYNJARDY XR T
ofloxacin OGIVRI [INJ] [SP] olanzapine olmesartan olmesartan/hctz omega-3 acid ethyl esters omeprazole delayed-release OMNIPOD 5: KITS, PODS OMNIPOD DASH: KITS, PODS OMNIPOD GO: PODS OMNITROPE [INJ] [SP] OMVOH [INJ] [SP] ondansetron ondansetron orally disintegrating tablets ORIAHNN ORILISSA ORTHOVISC [INJ] [SP] oseltamivir OTEZLA [SP] OVIDREL [INJ] [SP] oxcarbazepine oxybutynin ext-release oxycodone oxycodone/acetaminophen OZEMPIC [INJ] P PANCREAZE pantoprazole delayed-release paroxetine hcl PAXLOVID penicillin v potassium PENTASA 250MG CAPSULES pioglitazone PIQRAY [SP] PLEGRIDY [INJ] [SP] polymyxin/trimethoprim eye solution POMALYST [SP] potassium chloride ext-release pramipexole pravastatin PRECISION XTRA: METERS, TEST STRIPS, B-KETONE STRIPS [OTC] prednisolone acetate eye suspension prednisolone sodium phosphate OPSUMIT [SP] OPSYNVI [SP] ORALAIR [SP] PHEBURANE [SP] PHESGO [INJ] [SP] PIFELTRO [SP] progesterone micronized PROLASTIN C [INJ] [SP] promethazine promethazine/dextromethorphan propranolol propranolol ext-release Q quetiapine quinapril QULIPTA QVAR REDIHALER prednisone pregabalin PREGNYL [INJ] [SP] PREMARIN CREAM prenatal vitamins PROCRIT [INJ] [SP]
TAKHZYRO [INJ] [SP] TALICIA TALTZ [INJ] [SP] TALZENNA [SP] tamoxifen tamsulosin ext-release TANDEM MOBI CARTRIDGE, KIT, SYSTEM TAVALISSE [SP] TECHLITE LANCETS [OTC] telmisartan terazosin terconazole vaginal teriflunomide [SP] testosterone cypionate [INJ] TEZSPIRE [INJ] [SP] thyroid timolol maleate eye solution tiotropium powder inhaler tizanidine TOBI PODHALER [SP] tobramycin eye solution tobramycin/dexamethasone eye suspension topiramate topiramate ext-release torsemide TOUJEO [INJ] TRACLEER SUSPENSION [SP] tramadol trazodone 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, TRUETRACK [OTC] TRULANCE TRULICITY [INJ] TRELEGY ELLIPTA TREMFYA [INJ] [SP] treprostinil [INJ] [SP] TRESIBA [INJ] tretinoin topical triamcinolone topical
VELTASSA VEMLIDY venlafaxine
venlafaxine ext-release verapamil ext-release VERQUVO VERZENIO [SP] VGO VIBERZI vilazodone VIOKACE VITRAKVI [SP] VIVITROL [INJ] [SP] VIZIMPRO [SP] VOSEVI [SP] VOYDEYA [SP] VTAMA
VUMERITY [SP] VYNDAMAX [SP] VYNDAQEL [SP] W warfarin WEGOVY [INJ] X XACIATO XALKORI [SP] XARELTO XDEMVY [SP] XELJANZ, XELJANZ SOLUTION, XELJANZ XR [SP] XHANCE XIFAXAN XIGDUO XR 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 Z ZELBORAF [SP] ZEMAIRA [INJ] [SP] ZENPEP ZEPATIER [SP] ZEPBOUND PEN [INJ] ZEPOSIA [SP] ZIEXTENZO [INJ] [SP] ZIRABEV [INJ] [SP] zolpidem zolpidem ext-release ZOMIG 2.5MG NASAL ZORYVE 0.15% CREAM ZTLIDO ZUBSOLV ZURZUVAE [SP] ZYKADIA [SP] ZYMFENTRA [INJ] [SP]
TRUQAP [SP] TWIIST: KITS TYENNE [INJ] [SP] TYMLOS [INJ] [SP] TYVASO DPI [SP] U UBRELVY
UPTRAVI TABLETS [SP] USTEKINUMAB-TTWE (by Quallent) [INJ] [SP] UZEDY [INJ] V valacyclovir valsartan valsartan/hctz VALTOCO VANRAFIA [SP] varenicline VARUBI VASCEPA VELSIPITY [SP]
TABRECTA [SP] tacrolimus topical tadalafil TAFINLAR [SP] TAGRISSO [SP]
For Stelara, see Exclusion Document for more information.
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.
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CRP1476501 #1702 NP-A PRMT22157-26 (08/08/2025)
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