2026 formulary coverage changes
CarePartners of Connecticut is incorporating a number of updates to our drug formularies for the 2026 plan year, which are summarized below.
Drugs moving to non-covered status
Effective for fill dates on or after Jan. 1, 2026, we will no longer cover certain drugs, including drugs with interchangeable generics or therapeutic alternatives, for members of the plans indicated above. Refer to this document (page 1) for the list of drugs moving to non-covered status.
For members currently taking these drugs, coverage will continue without disruption through Dec. 31, 2025. If you are a prescribing provider and you wish for a member to continue taking a drug on this list, you’ll need to submit a formulary exception request.
Drugs moving to a higher tier
For fill dates on or after Jan. 1, 2026, certain drugs will be moving to a higher tier. Click here to review a list of these drugs, which you’ll find on page 2. For members currently taking these drugs, their current coverage will continue unchanged through Dec. 31, 2025.
If an impacted patient cannot afford the new copay, please refer to the formulary for potential therapeutic alternatives at lower tiers. If the available alternatives are not clinically appropriate, a tier exception can be requested and will be reviewed in accordance with CMS regulations, as not all drugs are eligible for tier exceptions.
Additional changes
Refer to page 3 of the 2026 formulary changes document for information about additional updates. These include:
- The addition of quantity limits for certain medications
- New prior authorization requirement for Revcovi
- A preferred product change for diabetic testing supplies
- Drugs excluded under Medicare law which will no longer be covered as an enhanced benefit