Medicaid Formulary Updates, Eff 4.1.2026

Drug Class

Preferred Products 

 Non-Preferred***

**Continuation of Non-Formulary Medication Permitted (Y/N)

New Drug Recommendations

No New Preferred drugs

Anzupgo

Bluejepa

Jascayd

Palsonify

Wayrilz

Tryptyr

No

Drug Class

Preferred Products  

 Non-Preferred

**Continuation of Non-Formulary Medication Permitted (Y/N)

Antidepressants, Other

bupropion (ORAL)*

bupropion SR (ORAL)* bupropion XL (ORAL)* desvenlafaxine ER (PRISTIQ) (ORAL)(new)

mirtazapine ODT (ORAL)* mirtazapine tablet (ORAL)

Spravato (NASAL) *

trazodone (ORAL)*

venlafaxine (ORAL)* venlafaxine ER capsules (ORAL)*

Zurzuvae (ORAL)*

Remaining Agents are non-preferred.

No

Antivirals, Topical

acyclovir cream (TOPICAL)

acyclovir ointment (TOPICAL)* docosanol OTC (TOPICAL)*

acyclovir cream (AG) (TOPICAL)

No

Drug Class

Preferred Products 

 Non-Preferred

**Continuation of Non-Formulary Medication Permitted (Y/N)

Bladder Relaxant Preparations

fesoterodine ER (ORAL)* (new)

oxybutynin ER (ORAL)* oxybutynin syrup (ORAL)* oxybutynin tablet (ORAL)* solifenacin (ORAL) (new)

tolterodine (ORAL)*

tolterodine ER (AG) (ORAL)

Detrol La (ORAL)*

Detrol (ORAL)* iii)

Toviaz (ORAL)*

No

Bone Resorption Suppression and Related Agents

alendronate solution (ORAL)

alendronate tablets (ORAL)* Bildyos syringe (SC) (new) calcitonin Salmon (NASAL)* Forteo (SC.) *

ibandronate tablets (ORAL)*  raloxifene (AG) (ORAL)*

Osenvelt Vial (SC)

Prolia (SC) *

Stoboclo syinge (SC)

No

Enzyme Replacement, Gaucher Disease

Elelyso (IV)*

Miglustat (AG) (ORAL)*

Miglustat (ORAL)*

No

Hypoglycemics, Metformins

metformin (ORAL)*

metformin ER (Glucophage XR) (ORAL)*

glyburide-metformin (ORAL)*

No

Immune Globulins

Bivigam (IV)*

Cutaquig (SC) (new)

Flebogamma (IV)*

Gammagard Liquid (INJ)* Gammagard S-D (IV)*

Gammaked (IV)*

Gammaplex (IV) (new) Gamunex-C (INJ)*

Hizentra syringe (SC)*

Hizentra vial (SC.) *

Octagam (IV)*

Privigen (IV) *

Xembify (SC)*

Remaining Agents are non-preferred.

No

Drug Class

Preferred Products 

 Non-Preferred

**Continuation of Non-Formulary Medication Permitted (Y/N)

NSAIDs

(Note: Class not previously reviewed)

celecoxib (ORAL)*

diclofenac tablet (ORAL)

diclofenac sodium (ORAL)* diclofenac sodium gel OTC (TOPICAL)

diclofenac solution (TOPICAL)*

etodolac (ORAL)*

flurbiprofen (ORAL)*

ibuprofen capsule OTC (ORAL)*

ibuprofen suspension (ORAL)* ibuprofen tablet (ORAL)* ibuprofen tablet OTC (ORAL)*

indomethacin capsule (ORAL)* ketoprofen (ORAL)*

ketorlac (ORAL)*

meloxicam tablet (ORAL)* nabumetone (ORAL)*

naproxen sodium (ORAL)* naproxen sodium OTC (ORAL)

piroxicam (ORAL)*

sulindac (ORAL)*

Vyscoxa suspension (ORAL) with PA for patients >10 yrs and

Remaining Agents are non-preferred.

No

Oncology, Oral – Hematologic

hydroxyurea (ORAL)*

imatinib (ORAL)*

Imbruvica capsule (ORAL)* Imbruvica Suspension (ORAL)* Jakafi (ORAL)*

Matulane (ORAL)* mercaptopurine (ORAL)*

Revlimid (ORAL)* (new) Sprycel (ORAL)*

Tasigna (ORAL)*

tretinoin (ORAL)*

Imbruvica tablet (ORAL)

lenalidomide (ORAL)*

No

Otic Antibiotics

ciprofloxacin (OTIC)* diprofloxacin /dexamethasone (AG) (OTIC)*

ciprofloxacin / dexamethasone (OTIC)* neomycin/polymyxin/HC SOLN/SUSP (AG) (OTIC)* neomycin / polymyxin /HC SOLN/SUSP (OTIC)*

ofloxacin (OTIC)*

Cipro HC (OTIC)*

No

Drug Class

Preferred Products 

 Non-Preferred

**Continuation of Non-Formulary Medication Permitted (Y/N)

Oral and Inhaled Pulmonary Arterial Hypertension Agents

ambrisentan (ORAL)*

orenitram ER (ORAL)* orenitram titration kit (ORAL)*

sildenafil suspension (ORAL)* sildenafil tablet (ORAL)*

tadafil (ADCIRCA) (ORAL)* Tracleer suspension (ORAL)* Yutrepia cap W/DEV (INHALATION) (new)

Remaining Agents are non-preferred.

Yes

Thrombopoiesis Stimulating Agents

eltrombopag tablet (generic-Promacta) (ORAL)*(new)

Nplate (SUB-Q)*

Promacta suspension (ORAL)

Promacta tablet (ORAL)*

No

Ulcerative Colitis

mesalamine (Canasa) (ORAL)*

mesalamine (Canasa) (AG) (ORAL)*

mesalamine (Lialda) (ORAL) mesalamine (Lialda) (AG) (ORAL) (new)

mesalamine ER (Apriso) (ORAL)

mesalamine ER (Apriso) (AG) (ORAL)

Pentasa (ORAL)*

Sfrowasa (RECTAL)* sulfasalazine (AG) (ORAL)* sulfasalazine (ORAL)* sulfasalazine DR (AG) (ORAL)*

Remaining Agents are non-preferred.

No

Hereditary Angioedema Treatments

Berinert (INTRAVEN)*

Cinryze (INTRAVEN)* Haegarda (SUB-Q) (new) Icatibant (SUB-Q) *

Kalbitor (SUB-Q) *

Remaining Agents are non-preferred..

Yes

Pituitary Suppressive Agents, LHRH

Fensolvi 6-MONTH (SC)

Lupron Depot 1MO KIT (INJ)* Lupron Depot -PED 1-MONTH (INJ)*

Lupron Depot Pediatric 3-months

Lupron Depot Pediatric 6-months

Lupron Depot - 6-months

Remaining Agents are non-preferred.

Yes – only for the non-formulary pediatric options.