Pharmacy Formulary and Medical Policy Changes for January 2026

Beginning January 2026, some prescriptions will experience a formulary drug list change. Read more about the formulary drug list changes.

Premera is making additional changes to the Essentials formulary, including:

• Starting January 1, 2026, pharmacies filling non-covered medications will get a rejection message, along with information on preferred alternatives.
• The Essentials formulary exclusion list will be called the Essentials Non-Formulary list with preferred alternatives,
• In 2026, we’ll add more multisource brands, non-preferred biosimilars, and high-cost generics (with lower-cost options) to the High-Cost Low-Value (HCLV) and Essentials Non-Formulary lists.

Also, starting in January, the following drugs will require a new prior authorization:

How we’re notifying members: Impacted members received a letter in November 2025 notifying them of the change. The member’s provider was also notified of the change in our October 2, 2025, issue of Provider News.

If you have any questions about these formulary and prior authorization changes, please contact your Premera representative.