Formulary Updates

Updated May 1, 2026

Pharmacy Benefits Advisory Committee (PBAC) Updates

The Pharmacy Benefits Advisory Committee (PBAC), consisting of clinical subject matter experts within Michigan Medicine and the University of Michigan, meets regularly to review and approve changes to the Prescription Drug Plan formulary. Check the formulary for up to date formulary status. Formulary status is subject to change. Here are the latest updates.

July 2026

Effective July 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Product Added to Formulary

  • Aqvesme - Tier 2, specialty, PMP, PA, QL

Coverage Updates

  • Alendronate oral solution - Add AL
  • Avanafil tablet - Remove AL, remove GL, add ST
  • Desmopressin - Add QL
  • Mirabegron (Myrbetriq) - Add ST (if younger than age 65)
  • Omvoh - Move to non-formulary
  • Pyrukynd - Move to PMP
  • Rhofade - Add ST
  • Sildenafil, tadalafil, vardenafil tablet - Remove AL, remove GL
  • Sumatriptan-naproxen - Move to excluded
  • Tremfya - Move to Tier 3
  • Vardenafil ODT - Move to excluded
  • Voriconazole oral suspension - Add AL
  • Zinc (Galzin) - Move to excluded

June 2026

Effective June 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Cardamyst - Tier 3, PA, QL

  • Crenessity 25 mg capsule - Tier 2, specialty, LDD, PA, QL

  • Lasix Onyu - Tier 2, specialty, MMN, PA, QL

  • Omlonti - Tier 3, ST, QL

  • Redemplo - Tier 2, specialty, LDD, PA, QL

Coverage Updates

  • Rhopressa and Rocklatan - Change PA to ST, Add QL

May 2026

Effective May 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Brinsupri - Tier 2, specialty, PMP, PA, QL
  • Pivya - Tier 3, specialty, LDD, PA, QL
  • Blujepa - Tier 3, specialty, LDD, PA, QL
  • Myqorzo - Tier 2, specialty, LDD, PA, QL
  • Daybue Stix - Tier 2, specialty, LDD, PA, QL
  • SPS suspension - Tier 1
  • Orladeyo Pellet Packet - Tier 3, specialty, LDD, PA, QL
  • Gomekli - Tier 2, specialty, PMP, PA, QL

Coverage Updates

  • Basaglar - Move to excluded (other brands of insulin glargine U-100, such as Lantus, insulin glargine YFGN, and Rezvoglar, are still covered.)
  • Carbinoxamine ER suspension - Move to Tier 1, AL, QL
  • Toujeo - Move to excluded (unbranded insulin glargine U-300 still covered)
  • Veltassa - Move to non-formulary

April 2026

Effective April 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Fiasp - Tier 0
  • Hyrnuo - Tier 2, specialty, LDD, PA, QL
  • iLet - Tier 2, PA, QL
  • Kirsty - Tier 0
  • Komzifti - Tier 2, specialty, PMP, PA, QL, split fill
  • Lyumjev - Tier 0
  • Merilog - Tier 0
  • Orlynvah - Tier 3, specialty, LDD, PA, QL
  • Phyrago - Tier 3, specialty, LDD, PA, QL
  • Subvenite oral suspension - Tier 3, PA, QL
  • twiist - Tier 2, PA, QL
  • Vraylar 0.5, 0.75 mg - Tier 3, ST, QL
  • Wegovy tablet - Tier 3, MMN, PA, QL

Coverage Updates

  • Caffeine Citrate 60 mg/3 mL oral - Add PA, QL
  • Carglumic acid - Add PA, QL
  • Insulin glargine U-300 - Remove PA
  • Omnipod - Move to Tier 2
  • Sprix - Move to non-formulary, add QL
  • Synarel - Add PA, QL
  • Teglutik - Add PA, QL
  • Tobi Podhaler - Move to non-formulary, add QL

March 2026

Effective March 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Rhapsido - Tier 3, specialty, PMP, PA, QL
  • Leqselvi - Tier 2, specialty, PMP, PA, QL
  • Lynkuet - Tier 2, PA, QL
  • Zurnai - Tier 2, QL

Coverage Updates

  • Lokelma - Remove PA

February 2026

Effective Feb. 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Anzupgo - Tier 3, specialty, LDD, PA, QL
  • Brynovin - Tier 2, ST, QL
  • Doptelet sprinkle - Tier 3, specialty, MMN, PA, QL
  • Enbumyst - Tier 2, specialty, MMN, PA, QL
  • Inluriyo - Tier 2, specialty, PMP, PA, QL
  • Koselugo sprinkle - Tier 2, specialty, PMP, PA, QL
  • Wayrilz - Tier 3, specialty, PMP, PA, QL
  • Zoryve 0.05% cream - Tier 2, specialty, PMP, PA, QL
  • Jascayd - Tier 2, specialty, LDD, PA, QL

Coverage Updates

  • Lizkmez - Move to Tier 3, AL

January 2026

Effective Jan. 1, 2026, the following changes will be made to the Prescription Drug Plan’s formulary.

Coverage Updates

  • Ruconest - Move from Tier 2 to Tier 3

December 2025

Effective Dec. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary

  • Andembry - Tier 2, specialty, LDD, PA, QL
  • Dawnzera - Tier 2, specialty, LDD, PA, QL
  • Berinert - ​Tier 3, specialty, PMP, PA, QL
  • Spevigo 300 mg/2 mL - Tier 2, specialty, PMP, PA, QL
  • Brukinsa 160 mg tablet - Tier 2, specialty PMP, PA, QL
  • Prezcobix 675 mg-150 mg - Tier 2, specialty, HIV, QL
  • Skytrofa 0.7, 1.4, 1.8, 2.1, 2.5 mg - Tier 3, specialty, MMN, PA

November 2025

Effective Nov. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. 

New Products Added to Formulary

  • Modeyso - Tier 2, specialty, PMP, PA, QL
  • Hernexeos - Tier 2, specialty, PMP, PA, QL
  • Penmenvy - Tier 0, QL
  • Yeztugo - Tier 2, specialty, MMN, QL
  • Lopressor solution - Tier 3, AL

Coverage Updates

  • Nityr - Move to excluded (nitisinone capsules still covered)
  • Hemlibra - Move to excluded (available under medical benefit)
  • Ixchiq - Move to excluded (FDA license suspended)
  • Topiramate solution - Remove ST

October 2025

Effective Oct. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. 

New Products Added to Formulary

  • Hydrocodone-acetaminophen 10-325/15 oral solution - move to excluded (10-300/15 and 7.5-325/15 still covered)
  • Crotamiton - move to non-formulary
  • Edurant - added QL
  • Alunbrig - move to Tier 2
  • Diclofenac powder pack (Cambia) - remove PA, add AL, add ST
  • Clever Choice Chamber - move to NF

September 2025

Effective Sept. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. 

New Products Added to Formulary 

  • Hydrocodone-acetaminophen 10-300/15 - Tier 1, QL
  • Avmapki-Fakzynja - Tier 2, LDD, PA, QL
  • Ensacove - Tier 2, LDD, PA, QL
  • Ibtrozi - Tier 2, LDD, PA, QL
  • Tryptyr - Tier 3, PA, QL
  • Livmarli tablet - Tier 2, LDD, PA, QL

Coverage Updates

  • Metronidazole 375 mg capsule - move to excluded (250 mg splitable tablets still covered)

August 2025

Effective August 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary.

New Products Added to Formulary 

  • Bisolprolol 2.5 mg tablet - Tier 3, QL
  • Journavx - Tier 3, QL
  • Carbamazepine 200 mg chewable tablet - Tier 1
  • Romvimza - Tier 2, specialty, PMP, PA, QL
  • Ixchiq - Tier 0, QL, AL
  • Vimkunya - Tier 0, QL, AL
  • Tezruly - Tier 3, QL, AL
  • Vanrafia - Tier 2, specialty, LDD, PA, QL
  • Paxlovid 300/150-100 mg (severe) - Tier 2, QL, AL

Coverage Updates

  • Dapsone 5% gel - Remove PA
  • Dapsone 7.5% gel pump - Remove ST

July 2025

Effective July 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

Coverage Updates

  • Diabetes GLP-1s – Diagnosis confirmation required via PA
  • Lanthanum (Fosrenol) – Add ST

June 2025

Effective June 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Products Added to Formulary

  • Alyftrek – Tier 2, specialty, PMP, PA, QL
  • Ivermectin 6 mg tablet – Tier 1
  • Onapgo – Tier 3, PA, QL
  • Rezdiffra – Tier 3, specialty, LDD, PA, QL

Coverage Updates

  • Eucrisa – Add specialty, PMP flag
  • Ketoprofen ER – Move to excluded
  • Topiramate ER capsule – Add ST
  • Topiramate ER sprinkle capsule – Add ST
  • Trintellix – Add ST
  • Savella – Add ST
  • Velphoro – Move to NF
  • Veltassa 8.4, 16.8, and 25.2 gm packet – Add PA
  • Vtama – Move to Tier 2
  • Zoryve 0.15% cream – Move to Tier 2

May 2025

Effective May 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Products Added to Formulary

  • Tryngolza – Tier 2, specialty, LDD, PA, QL
  • Xromi – Tier 2, specialty, PMP, QL, AL
  • Revuforj – Tier 2, specialty, PMP, PA, QL
  • Prevymis pellet packet – Tier 2, specialty, MMN, PA, QL
  • nimodipine 60 mg/20 mL oral solution – Tier 1, specialty, PMP, QL, AL
  • Omvoh 200 mg and 300 mg – Tier 2, specialty, PMP, PA, QL
  • Veltassa 1 gm powder packet – Tier 2, MMN, specialty, PA, QL
  • Crenessity – Tier 2, LDD, PA, QL
  • Evrysdi tablet – Tier 2, specialty, LDD, PA, QL

Coverage Updates

  • Topiramate sprinkle capsule – added AL
  • Marplan – move to NF
  • Desvenlafaxine ER – move to NF
  • Fluvoxamine ER – move to NF
  • Olanzapine-fluoxetine – move to NF
  • Trazodone 300 mg tablet – move to NF
  • Chlordiazepoxide-amitriptyline – move to NF
  • Perphenazine-amitriptyline – move to NF
  • Trimipramine – move to NF
  • Nymalize – move to Tier 3
  • Ridaura – move to NF
  • Chlorzoxazone 250 mg tablet – move to excluded

April 2025

Effective April 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Attruby – Tier 2, specialty, PMP, PA, QL

Coverage Updates

  • Restasis multidose – Moved to non-formulary

March 2025

Effective March 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Aqneursa – Tier 2, specialty, LDD, PA, QL
  • Imkeldi – Tier 2, specialty, PMP, PA, QL
  • Miplyffa – Tier 3, specialty, LDD, PA, QL
  • Opfolda – Tier 2, specialty, LDD, PA, QL

Coverage Updates

  • Gocovri – Moved to non-formulary
  • Levonorgestrel-ethinyl estradiol-iron – Moved to non-formulary
  • Drospirenone-ethinyl estradiol-levomefolate – Moved to non-formulary
  • Osmolex – Added ST
  • Pramipexole ER – Added ST
  • Ropinirole ER – Added ST
  • Tolcapone – Moved to non-formulary

February 2025

Effective Feb. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Itovebi – Tier 2, specialty, LDD, PA, QL

March 2025

Effective March 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

Coverage Updates

  • Clozapine 150 mg and 200 mg ODT – moved to non-formulary
  • Versacloz – added AL

February 2025

Effective Feb. 1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

New Brand Products Added to Formulary

  • Cobenfy – Tier 3, ST, QL

  • Iqirvo – Tier 3, specialty, PMP, PA, QL

  • Lazcluze – Tier 2, specialty, PMP, PA, QL
  • Livdelzi – Tier 3, specialty, PMP, PA, QL
  • Vyalev – Tier 3, specialty, LDD, PA, QL

January 2025

Effective Jan.1, 2025, the following changes will be made to the Prescription Drug Plan’s formulary. Review the formulary.

Coverage Updates

Finacea foam – moved to tier 3, added ST