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  • Availity® Essentials
  • Availity® Essentials
  • Inicio Proveedores Noticias 2026 Drug List Formulary Updates

    2026 Drug List Formulary Updates

    Jan. 29, 2026

    Effective Jan. 1, 2026, we updated the HealthSpring Medicare Advantage Prescription Drug formularies.

    To support seamless treatment decisions and care planning, please review the 2026 Medicare Advantage formulary changes. Most members will receive written notification of any changes that may limit access to maintenance medications.

    If a formulary alternative is appropriate for your patient, please prescribe it. If no substitute is available, beginning Jan. 1, 2026, submit a prior authorization request. Refer to Medicare Coverage Decisions and Exceptions for more information.

    2026 Formulary Updates
    Effective Jan. 1, 2026, these medications will no longer be covered. Please review the 2026 full formulary for a complete list of covered medications.

    Significant 2026 MAPD formulary removals
    Condition
    Formulary removal
    2026 formulary alternative
    Diabetes
    Bydureon BCISE
    Ozempic, Mounjaro, Trulicity
    Glyxambi
    SGLT-2 (Farxiga or Jardiance) PLUS DPP-4 (Januvia or Tradjenta)
    Synjardy/Synjardy XR
    Xigduo XR
    Tresiba1
    Lantus, Toujeo
    Trijardy XR
    SGLT-2 (Farxiga or Jardiance) PLUS DPP-4 (Januvia or Tradjenta) PLUS metformin
    Diabetes blood glucose monitoring2
    LifeScan OneTouch blood glucose meters and test strips
    Abbot’s FreeStyle Lite, Precision Neo, Libre, and Dexcom G6, G7
    Inflammatory conditions
    Humira
    Hadlima
    Inflectra
    Remicade
    Yuflyma
    Hadlima
    Migraine
    Ajovy
    Aimovig
    Antipsychotic
    Uzedy
    Risperidone ER vial
    Osteoporosis
    Forteo
    Teriparatide
    Tymlos
    Teriparatide

    1 When switching between basal insulin therapies, the American Diabetes Association recommends that “doses can be converted unit for unit and subsequently adjusted based on glucose monitoring; however, an initial dose reduction of 10–20% can be used for individuals in very tight management or at high risk for hypoglycemia.” Refer to the ADA’s Standards of Care in Diabetes or the prescribing information for additional information.

    2 Covered under Part B for Medicare Advantage members, $0 copay for preferred diabetes meters and meter supplies. Coverage: One glucose monitor or one continuous glucose monitor (CGM) every two years; 200 test strips or three sensors per 30-day period (depending on the monitor). Preferred devices: Abbott Diabetes Care – FreeStyle Lite, FreeStyle Freedom Lite, FreeStyle Precision Neo and FreeStyle Libre (CGM); and Dexcom G6 (CGM) and Dexcom G7 (CGM).

    Significant 2026 MAPD formulary additions
    Condition
    Formulary addition
    2026 formulary status
    Antipsychotic
    Risperidone ER vial
    T4/5 QL
    Asthma/COPD
    Spiriva Respimat
    T4 ST/QL
    Atopic dermatitis
    Zoryve 0.15% cream
    T4 PA/QL
    Diabetes
    Dapagliflozin
    T3 QL
    Fiasp, insulin aspart, Novolin, Novolog3
    T3
    Inflammatory conditions
    Hadlima
    T5 PA/QL
    Kineret
    T5 PA/QL
    Selarsdi
    T3/5 PA/QL
    Stelara
    T5 PA/QL
    Tyenne
    T5 PA/QL
    Multiple sclerosis
    Teriflunomide
    T5 PA/QL
    Osteoporosis
    Teriparatide
    T5 PA/QL
    Potassium binder
    Lokelma
    T3
    Pulmonary hypertension
    Winrevair
    T5 PA/QL

    3 $35 insulin per 30-day supply (see formulary for a complete list of covered insulins).