2026 Formulary Changes: Express Scripts
Posted on December 16, 2025
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The following is an analysis of the Express Scripts (ESI) 2026 formulary changes for the National Preferred Formulary (NPF), effective January 1, 2026. PSG’s clinical team evaluated the changes, including an impact analysis based on our book-of-business dataset, to provide an overview of the most important considerations.
Notable Express Scripts Formulary Changes
- The member and financial impact of Express Scripts’ 2026 exclusions are much higher compared to that of its 2025 formulary exclusions, with more than double the amount of exclusions.
- The diabetes category will see the largest impact due to the removal of several products, including One Touch diabetes supply and Humalog vials.
- Multi-source brand products, Symbicort and Vyvanse, will have meaningful member impact, particularly potential supply concerns for generic Vyvanse.
- Brand Stelara is being phased out in favor of biosimilars, starting with IV (intravenous) removal in January 2026 and full SC (subcutaneous) removal by July 2026.
- Two injectable schizophrenia treatments are being removed from the formulary in a sometimes difficult-to-treat population, where patients may be more sensitive to the changes.
| National Preferred Formulary | |
|---|---|
| New Exclusions for January 2026 | 48 |
| Number of Exclusions – Specialty Drugs | 13 |
| New Multi-Source Brand Exclusions for January 2026 | 10 |
| Number of MS Exclusions – Specialty Drugs | 4 |
| % Members Impacted | 1.8% |
| Total Drug Spend Impact | 0.48%% |
Express Scripts Formulary Change Impact
ESI has the most changes to their formulary, with 48 drug exclusions from its National Preferred Formulary. This is more than double last year’s 21 changes. Overall, the percentage of members and drug spend impacted by the 2026 changes will be higher than in 2025.
Two brand removals are expected to drive some of the most significant member impact in 2026. The first is Symbicort, a prescription inhaler indicated for asthma and chronic obstructive pulmonary disease (COPD). The second is Vyvanse (lisdexamfetamine), used for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Both are multi-source brands with equivalent generics available, so member disruption should be minimal. However, concerns remain regarding the adequate supply of generic Vyvanse, which could present challenges.
In the asthma category, Arnuity Ellipta (fluticasone furoate) will also be excluded, though its impact is expected to be limited.
Beyond these changes, the most significant member impact from the 2026 formulary updates will occur in the diabetes category, driven by multiple product removals.
Diabetes Changes
LifeScan, the manufacturer of One Touch diabetes supplies, filed for bankruptcy earlier in 2025, which may lead to potential shortages. In response, ESI will prefer Abbott and Trividia Health meters and test strips. Affected members will be able to receive a free meter of the preferred product. The removal of One Touch diabetes supplies is expected to have a significant impact in 2026. Also contributing to the formulary impact is the removal of Humalog vials. However, other Humalog dosage formulations will remain available.
Stelara and Other Biosimilars
Thirteen specialty drugs will be excluded in relation to biosimilar changes.
Leading the way is brand Stelara (ustekinumab). The IV (intravenous) formulation will be removed effective 1/1/2026, as well as the SC (subcutaneous) version for members new to therapy. The bigger patient impact will occur on 7/1/2026 when Stelara SC will be excluded for all utilizers. This biosimilar change will occur nearly a year and a half after Stelara biosimilars officially entered the market. Compared with Humira and its biosimilars, the removal is happening about a year earlier. The removal of brand Humira occurred two and a half years after biosimilars became available to Express Scripts’ members. Alternatives to brand Stelara will include the biosimilars Selarsdi, ustekinumab-ttwe by Quallent, and Yesintek.
It is important to note that not all of our book-of-business clients followed the standard formulary recommendations for Stelara and its biosimilars. Some have already removed brand Stelara, and others are considering removal on 1/1/2026.
Other Biosimilar Changes
- Brand Actemra, used to reduce inflammation in autoimmune and inflammatory conditions, will be removed and replaced with its biosimilar, Tyenne.
- Brand Soliris, used for rare and severe autoimmune and hematologic conditions, will be removed and replaced with its biosimilar, Epysqli.
- Humira biosimilar, Cyltezo, will be excluded.
- Remicade biosimilar, Inflectra, will be excluded.
- Herceptin biosimilars, Kanjinti and Trazimera, will be excluded.
Oncology and Other Exclusions
Two notable multi-source brand oncology drugs, Tasigna (nilotinib) and Revlimid (lenalidomide), will be excluded on 1/1/2026. Revlimid, however, will have a phased approach with exclusions for new starts effective 1/1/2026 and for existing utilizers on 4/1/2026.
Another exclusion that could impact oncology patients is the removal of the narcotic pain medication, brand OxyContin, which will join its generic version on the exclusion list. OxyContin is used for pain relief when chronic pain medication is needed. Alternatives will include hydrocodone, hydromorphone, morphine, and oxymorphone products. Express Scripts will allow continuation of coverage for members who are using OxyContin for chronic cancer and non-cancer pain.
Injectable Antipsychotic Update
Express Scripts will not be removing the long-acting injectable antipsychotics, Invega Sustenna or Invega Trinza, from the NPF formulary as previously announced. Late negotiations allowed for the continuation of coverage of these drugs in this sensitive therapeutic category and will cause no member disruption.
Final Thoughts
Unlike Express Scripts’ 2025 formulary changes, the member and financial impact of this year’s formulary changes will be large. The primary driver is the removal of several diabetes products, particularly glucose monitoring supplies. While multi-source brand products such as Symbicort and Vyvanse also face removal, disruption should remain minimal provided generic alternatives are available. If any of these areas are particularly relevant to your business, they are well worth monitoring as you head into 2026.
Need help navigating 2026 formulary changes? PSG has the unbiased clinical and market expertise you need. Contact us today to learn more.
