2026 Formulary Changes: Optum Rx
Posted on December 16, 2025
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The following is an analysis of the Optum Rx 2026 formulary changes for the Premium Formulary (PF), 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 Optum Rx Formulary Changes
- The member and financial impact of Optum’s 2026 exclusions are similar to that of its 2025 formulary exclusions.
- Only one specialty drug is impacted by the changes: brand Copaxone (glatiramer acetate) 40 mg for the treatment of relapsing multiple sclerosis (MS).
- Ajovy (fremanezumab), an injectable CGRP migraine drug, will be removed from the formulary, requiring members to switch to other preferred injectable CGRP drugs.
- Recently approved generics will be added to the formulary, replacing several brand name alternatives.
| Premium Formulary | |
|---|---|
| New Exclusions for January 2026 | 12 |
| Number of Exclusions – Specialty Drugs | 1 |
| New Multi-Source Brand Exclusions for January 2026 | 7 |
| Number of MS Exclusions – Specialty Drugs | 0 |
| % Members Impacted | 0.56% |
| Total Drug Spend Impact | 0.84% |
Optum Rx Formulary Change Impact
Similar to the 2025 formulary changes, Optum Rx has a limited number of updates that will be effective 1/1/2026. Overall, the percentage of members and drug spend impacted by the 2026 formulary changes is slightly higher than in 2025.
Specialty Drug Impact
Only one specialty drug is impacted: brand Copaxone 40mg for the treatment of relapsing MS. Until now, the brand has remained on the formulary despite the first generic equivalent entering the market in October 2017. The removal of the brand Copaxone 40mg is not expected to cause significant member disruption, according to our PSG book of business analysis.
Other Notable Exclusions
A few brand drugs with available generics will be removed. Their generics will serve as alternatives, so member disruption should be minimal.
- The generic versions of Entresto (sacubitril/valsartan), a drug used for chronic heart failure, were released in July 2025. Compared to other drugs included in the 1/1/2026 changes, Entresto has a higher utilization. However, with the generic serving as the alternative, there should be minimal or no disruption to members.
- Brilinta (ticagrelor) is an antiplatelet drug used to lower the risk of heart attack, stroke, and related death in patients who have already experienced a heart attack. Although the generic version of this drug was approved in 2018, it only recently became available to the market in July 2025.
- Ajovy (fremanezumab), an injectable drug used for migraine prevention, will be excluded. Aimovig (erenumab) and Emgality (galcanezumab) will serve as its alternatives. Like Ajovy, these alternatives are also CGRP antagonists. However, there may be some member disruption because migraine treatment can often be patient-specific.
Final Thoughts
Similar to Optum Rx’s 2025 formulary changes, the member and financial impact of this year’s formulary changes will be minimal. However, there are a few brand name drugs being removed that are worth monitoring, especially if they impact your member population.
Need help navigating 2026 formulary changes? PSG has the unbiased clinical and market expertise you need. Contact us today to learn more.
