Medicare Formulary Change History
BRAND-NAME DRUGS are CAPITALIZED. Generic drugs are lower-case.
| Effective Date | Drug Name | Drug Class | Type of Change | Previous Coverage Status | New Coverage Status | ||
|---|---|---|---|---|---|---|---|
| 2026-06-01 00:00:00 | ceftaroline fosamil 400mg intravenous recon soln | CEPHALOSPORINS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | ceftaroline fosamil 600mg intravenous recon soln | CEPHALOSPORINS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | dapagliflozin-metformin 10-1,000mg oral tablet, IR - ER, biphasic 24hr | DIABETES THERAPY | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | dapagliflozin-metformin 5-1,000mg oral tablet, IR - ER, biphasic 24hr | DIABETES THERAPY | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 10mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 100mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 25mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 50mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 75mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | brivaracetam 10mg/mL oral solution | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | TRUQAP 160MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | DOPTELET SPRINKLE 10MG ORAL CAPSULE, SPRINKLE | COAGULATION THERAPY | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | milnacipran 100mg oral tablet | OTHER RHEUMATOLOGICALS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | milnacipran 12.5mg oral tablet | OTHER RHEUMATOLOGICALS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | milnacipran 50mg oral tablet | OTHER RHEUMATOLOGICALS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | milnacipran 25mg oral tablet | OTHER RHEUMATOLOGICALS | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | PROLIA 60MG/ML SUBCUTANEOUS SYRINGE | OSTEOPOROSIS THERAPY | Add | Non-formuary | Formulary | ||
| 2026-06-01 00:00:00 | ZYDELIG 100MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | ZYDELIG 150MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | IBRANCE 100MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | IBRANCE 75MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | TAZVERIK 200MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | bacitracin 500unit/gram ophthalmic (eye) ointment | ANTIBIOTICS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | levonorgestrel-ethinyl estrad 0.15-0.03mg oral tablet | ORAL CONTRACEPTIVES / RELATED AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-06-01 00:00:00 | dapagliflozin 10mg oral tablet | DIABETES THERAPY | Update | Drug Label Type: 6 | Drug Label Type: 1 | ||
| 2026-06-01 00:00:00 | dapagliflozin 5mg oral tablet | DIABETES THERAPY | Update | Drug Label Type: 6 | Drug Label Type: 1 | ||
| 2026-06-01 00:00:00 | VERZENIO 50MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 60 Day Supply: 30 | Quantity Limit: 56 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | VERZENIO 100MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 60 Day Supply: 30 | Quantity Limit: 56 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | VERZENIO 150MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 60 Day Supply: 30 | Quantity Limit: 56 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | VERZENIO 200MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 60 Day Supply: 30 | Quantity Limit: 56 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | IMBRUVICA 70MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 30 Day Supply: 30 | Quantity Limit: 28 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | IMBRUVICA 140MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 30 Day Supply: 30 | Quantity Limit: 28 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | IMBRUVICA 280MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 30 Day Supply: 30 | Quantity Limit: 28 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | IMBRUVICA 420MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Quantity Limit: 30 Day Supply: 30 | Quantity Limit: 28 Day Supply: 28 | ||
| 2026-06-01 00:00:00 | KINERET 100MG/0.67 ML SUBCUTANEOUS SYRINGE | OTHER RHEUMATOLOGICALS | Update | Quantity Limit: 20.1 Day Supply: 30 | Quantity Limit: 18.76 Day Supply: 28 | ||
| 2026-05-01 00:00:00 | pomalidomide 1mg oral capsule | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | pomalidomide 2mg oral capsule | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | pomalidomide 3mg oral capsule | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | pomalidomide 4mg oral capsule | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | levetiracetam 250mg oral tablet for suspension | ANTICONVULSANTS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | levetiracetam 500mg oral tablet for suspension | ANTICONVULSANTS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | XPOVIO 80 MG/WEEK(80 MG X 1) ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formulary | Formulary | ||
| 2026-05-01 00:00:00 | POMALYST 1MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | POMALYST 2MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | POMALYST 3MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | POMALYST 4MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | cyclophosphamide 25mg oral tablet | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | FLAC OTIC OIL 0.01% OTIC (EAR) DROPS | MISCELLANEOUS OTIC PREPARATIONS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | XPOVIO 40 MG/WEEK(40 MG X 1) ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | TRUQAP 160MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | erythromycin ethylsuccinate 400mg oral tablet | ERYTHROMYCINS / OTHER MACROLIDES | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | LEVORA-28 0.15-0.03MG ORAL TABLET | ORAL CONTRACEPTIVES / RELATED AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | SRONYX 0.1-20MG-MCG ORAL TABLET | ORAL CONTRACEPTIVES / RELATED AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | hydrocodone-acetaminophen 10-325mg/15 mL oral solution | NARCOTIC ANALGESICS | Delete | Formulary | Non-formulary | ||
| 2026-05-01 00:00:00 | OPIPZA 2MG ORAL FILM | PSYCHOTHERAPEUTIC DRUGS | Update | Step Therapy Step: 2 | Step Therapy Step: 1 | ||
| 2026-05-01 00:00:00 | OPIPZA 5MG ORAL FILM | PSYCHOTHERAPEUTIC DRUGS | Update | Step Therapy Step: 2 | Step Therapy Step: 1 | ||
| 2026-05-01 00:00:00 | OPIPZA 10MG ORAL FILM | PSYCHOTHERAPEUTIC DRUGS | Update | Step Therapy Step: 2 | Step Therapy Step: 1 | ||
| 2026-05-01 00:00:00 | sodium oxybate 500mg/mL oral solution | PSYCHOTHERAPEUTIC DRUGS | Update | Drug Label Type: 6 | Drug Label Type: 1 | ||
| 2026-03-01 00:00:00 | teriparatide 20 mcg/dose(560mcg/2.24mL) subcutaneous pen injector | OSTEOPOROSIS THERAPY | Update | Drug Label Type 5 | Drug Label Type 1 | ||
| 2026-03-01 00:00:00 | IMBRUVICA 140MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Update | Drug Label Type: 1 Quantity Limit: 30 | Drug Label Type: 4 Quantity Limit: 90 | ||
| 2026-03-01 00:00:00 | ABIGALE 1-0.5MG ORAL TABLET | ESTROGENS / PROGESTINS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | BOMYNTRA 120 MG/1.7 ML(70 MG/ML) SUBCUTANEOUS SOLUTION | ADJUNCTIVE AGENTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | BOMYNTRA 120 MG/1.7 ML(70 MG/ML) SUBCUTANEOUS SYRINGE | ADJUNCTIVE AGENTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | CONEXXENCE 60MG/ML SUBCUTANEOUS SYRINGE | OSTEOPOROSIS THERAPY | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | EDURANT PED 2.5MG ORAL TABLET FOR SUSPENSION | ANTIVIRALS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | HERNEXEOS 60MG ORAL TABLET | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | IBTROZI 200MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | KERENDIA 40MG ORAL TABLET | ANTIHYPERTENSIVE THERAPY | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | MODEYSO 125MG ORAL CAPSULE | ANTINEOPLASTIC / IMMUNOSUPPRESSANT DRUGS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | ORQUIDEA 0.35MG ORAL TABLET | ESTROGENS / PROGESTINS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | PENMENVY MEN A-B-C-W-Y (PF) 0.5ML INTRAMUSCULAR KIT | VACCINES / MISCELLANEOUS IMMUNOLOGICALS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 10mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 12mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 2mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 4mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 6mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | perampanel 8mg oral tablet | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | rivaroxaban 1mg/mL oral suspension for reconstitution | COAGULATION THERAPY | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | sacubitril-valsartan 24-26mg oral tablet | MISCELLANEOUS CARDIOVASCULAR AGENTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | sacubitril-valsartan 49-51mg oral tablet | MISCELLANEOUS CARDIOVASCULAR AGENTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | sacubitril-valsartan 97-103mg oral tablet | MISCELLANEOUS CARDIOVASCULAR AGENTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | tolvaptan (polycys kidney dis) 15mg oral tablet | MISCELLANEOUS HORMONES | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | tolvaptan (polycys kidney dis) 30mg oral tablet | MISCELLANEOUS HORMONES | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | topiramate 25mg/mL oral solution | ANTICONVULSANTS | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | ustekinumab-aekn 45mg/0.5 mL subcutaneous syringe | ANTIPSORIATIC / ANTISEBORRHEIC | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | ustekinumab-aekn 90mg/mL subcutaneous syringe | ANTIPSORIATIC / ANTISEBORRHEIC | Add | Non-formuary | Formulary | ||
| 2026-03-01 00:00:00 | ABELCET 5MG/ML INTRAVENOUS SUSPENSION | ANTIFUNGAL AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | ENTRESTO 24-26MG ORAL TABLET | MISCELLANEOUS CARDIOVASCULAR AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | ENTRESTO 49-51MG ORAL TABLET | MISCELLANEOUS CARDIOVASCULAR AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | ENTRESTO 97-103MG ORAL TABLET | MISCELLANEOUS CARDIOVASCULAR AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | EPITOL 200MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | EPRONTIA 25MG/ML ORAL SOLUTION | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 10MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 12MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 2MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 4MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 6MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | FYCOMPA 8MG ORAL TABLET | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | IXCHIQ (PF) 1,000TCID50/0.5 ML INTRAMUSCULAR RECON SOLN | VACCINES / MISCELLANEOUS IMMUNOLOGICALS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | JYNARQUE 15MG ORAL TABLET | MISCELLANEOUS HORMONES | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | JYNARQUE 30MG ORAL TABLET | MISCELLANEOUS HORMONES | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | KELNOR 1/50 (28) 1-50MG-MCG ORAL TABLET | ORAL CONTRACEPTIVES / RELATED AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | REGRANEX 0.01% TOPICAL GEL | MISCELLANEOUS DERMATOLOGICALS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | REPATHA PUSHTRONEX 420MG/3.5 ML SUBCUTANEOUS WEARABLE INJECTOR | LIPID/CHOLESTEROL LOWERING AGENTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | SPRITAM 1,000MG ORAL TABLET FOR SUSPENSION | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | SPRITAM 750MG ORAL TABLET FOR SUSPENSION | ANTICONVULSANTS | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | STELARA 45MG/0.5 ML SUBCUTANEOUS SYRINGE | ANTIPSORIATIC / ANTISEBORRHEIC | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | STELARA 90MG/ML SUBCUTANEOUS SYRINGE | ANTIPSORIATIC / ANTISEBORRHEIC | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | ustekinumab 45mg/0.5 mL subcutaneous syringe | ANTIPSORIATIC / ANTISEBORRHEIC | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | ustekinumab 90mg/mL subcutaneous syringe | ANTIPSORIATIC / ANTISEBORRHEIC | Delete | Formulary | Non-formulary | ||
| 2026-03-01 00:00:00 | XARELTO 1MG/ML ORAL SUSPENSION FOR RECONSTITUTION | COAGULATION THERAPY | Delete | Formulary | Non-formulary |
| Effective Date | Drug Name | Type of Change | Previous Coverage Status | New Coverage Status |
|---|---|---|---|---|
| 2026-06-01 00:00:00 | FLORAFOL FE PEDIATRIC | Drop | Formulary | Non-formulary |
| 2026-06-01 00:00:00 | FLORAFOL PEDIATRIC | Drop | Formulary | Non-formulary |
| 2026-05-01 00:00:00 | WEGOVY HD | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 2.5 MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 5 MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 7.5 MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 10MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 12.5MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | ZEPBOUND KWIKPEN 15MG/0.6ML | Add | Non-Formulary | Formulary |
| 2026-04-01 00:00:00 | REFRESH OPTIVE MEGA-3 PF | Add | Non-Formulary | Formulary |
| 2026-03-01 00:00:00 | DIMETANE 25 MG | Add | Non-Formulary | Formulary |
| 2026-03-01 00:00:00 | ULTRA LIDO 4% | Drop | Formulary | Non-formulary |
Page Last Updated: 06/17/2026