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2026 mid‑year formulary updates

Express Scripts® Pharmacy Benefit Services continues its commitment to clinically appropriate, cost-effective prescription drug coverage.

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2026 mid‑year formulary updates

Effective July 1, 2026, Express Scripts is introducing mid‑year formulary enhancements across National Preferred, Flex, Basic, and High‑Performance formularies. These updates focus on excluding high‑cost products that do not demonstrate additional clinical value, while preserving access to preferred, clinically appropriate alternatives. 

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What's changing

National Preferred and Flex Formularies

Thirteen additional products will be excluded.

99.98% of National Preferred members and 100% of Flex members are expected to have no pharmacy counter disruption.

View the list of new National Preferred Formulary exclusions and preferred alternatives

View the list of new Flex Formulary exclusions and preferred alternatives

Basic and High‑Performance Formularies

Additional mid‑year optimization opportunities identified to support client and member savings.

View the list of new exclusions and preferred alternatives

Inflammatory conditions strategy reminder

As previously communicated, STELARA® SC will be excluded from the National Preferred Formulary effective July 1, 2026, and will transition to non‑preferred status on the Basic Formulary. This aligns with a broader strategy to improve affordability and access through biosimilar options. 

Client and member support:

No action is required from consultants

Clients were notified of these changes on March 17, 2026

Members required to switch medications will receive individualized communications, including alternative options and transition guidance

Previous updates

Clients notified on August 19, 2025

2026 annual formulary updates

Our mutual clients are committed to having the most up-to-date, clinically appropriate and cost effective prescription drug coverage for their members. Because of our partnership with thousands of clients, we use our unmatched scale and proven track record to advocate on their behalf, leveraging negotiations to provide competitive pricing. When clinical considerations align with these opportunities, patients and payers benefit.

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What you need to know

Annual changes to the National Preferred Formulary

On January 1, 2026, we will exclude 50 additional products from the National Preferred Formulary, demonstrating our commitment to minimizing health care waste by excluding high-cost medications that may not provide greater clinical results.

View the list of new exclusions and preferred alternatives
Over
99%
of members will have no disruption at the pharmacy counter1
Annual changes to the National Preferred Flex Formulary

On January 1, 2026, we will exclude 47 additional products from the Flex Formulary. The National Preferred Flex Formulary gives clients a pathway to cover alternative products with lower list prices.

View the list of new exclusions and preferred alternatives
Over
99%
of members will have no disruption at the pharmacy counter1

Annual changes to the Basic and High Performance Formularies

Additional opportunities were identified for Basic and High Performance to help client and member savings. Detailed 2026 annual status updates for these formularies are now available.

What you need to know

Supporting clients and their members

The small percentage of members being asked to switch to preferred medications will receive personalized outreaches, including a list of alternative medications and information on switching to a preferred product.

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No action is required from you, but optionality is available

Clients were notified of these changes on August 19, 2025. To encourage faster adoption of biosimilars, alternative utilization management offerings rolled out earlier this year are available. Clients should contact their account team to determine eligibility and an effective date.

Questions? Contact our team.

Sources

  1. Express Scripts claims data, 3/15/25-7/22/25