26-043 Medicare Part D Formulary Changes: Review Updates for 2026
Date: 01/20/26
Review the updated list of affected medications and recommended alternatives to support patient care
Starting January 1, 2026, several medications will no longer be covered under our Medicare Part D formulary. To help physicians transition, we have listed below the most commonly prescribed medications being removed, along with their 2026 formulary alternatives. Please review the list below to identify suitable options for your patients.
If current medication must continue
If your patient must remain on their current medication, you must submit a Request for Medicare Drug Coverage Determination form with detailed medical justification on or after January 1, 2026.
Forms are available at Wellcare by Health Net protal, under Pharmacy Benefits > Coverage Determinations and Redeterminations > Drug Coverage Determination Forms.
Questions?
Contact Pharmacy Services at 800-867-6564, Monday through Friday, 8 a.m. to 8 p.m. Pacific time.
Formulary removals and replacement options for 2026
Please review this list to identify suitable options for your patients.
Product name | Formulary alternative(s) |
|---|---|
OneTouch® (Part B) | Accu-Chek® Guide and True Metrix® meters and strips |
Insulin Degludec (D/C)1 | Insulin Glargine-yfgn, Insulin Glargine U-300 |
Diclofenac 2% solution | Diclofenac 1.5% topical solution |
Humira® (adalimumab) | Cyltezo (adalimumab-adbm),1 Yuflyma (adalimumab-aaty),1 Tyenne (tocilizumab-aazg),1 Steqeyma (ustekinumab-stba),1 Cosentyx,1 Otezla,1 Rinvoq,1 Skyrizi,1 Tremfya1 |
Actemra® (tocilizumab) | |
Austedo®, Austedo XR® | Tetrabenazine,1 Ingrezza®1 |
Trulance | Linzess, Lubiprostone |
Bydureon BCise (D/C)1 | Mounjaro®,1 Ozempic®,1 Rybelsus®,1 Trulicity®1 |
Gammagard Liquid® | Gamunex-C®1 |
Xultophy® | Soliqua® |
Abiraterone 500 mg | Abiraterone 250 mg tab,1 Abirtega 250 mg tab1 |
Fasenra® | Dupixent®,1 Xolair®1 |
Vivitrol® | Acamprosate, Disulfiram, Naltrexone HCl tab |
Opsumit® | Adempas®,1 Ambrisentan,1 Bosentan,1 Sildenafil 20 mg,1 Tadalafil 20 mg,1 Uptravi®,1 Winrevair®1 |
1Prior authorization required; D/C: discontinued by manufacturer.
Need help? Contact us
If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center at the number listed below.
Provider Services
Line of business | Phone number | |
|---|---|---|
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medicare Supplement |
This information applies to Physicians.