6 Medicare Drug Lists Exclude Known Brands
TL/DR –
In 2026, Medicare Part D’s “Formulary”—the list of drugs covered by the insurance—is undergoing a significant transformation due to the Inflation Reduction Act’s financial pressures. Insurers are opting to replace expensive brand-name medications with cheaper alternatives, affecting six well-known drugs: Flovent for asthma, Humira for arthritis, Eliquis and Xarelto for blood thinning, Lantus and Levemir for insulin, Ozempic/Mounjaro for Type 2 Diabetes, and Restasis for chronic dry eye. If a Medicare user’s claim for these medications is denied, they are advised to consult their doctor on possible alternatives and, if necessary, file a “Formulary Exception Request” to get the original drug covered due to medical necessity.
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Medicare Part D Suffers Sweeping Drug List Changes: Popular Brands Dropped
January is a time of heightened anxiety for millions of seniors making their first trip to the pharmacy. Despite retaining the same Medicare Part D plan as the previous year, the drugs covered by the plan may have changed. In 2026, the Formulary, which is the master list of drugs your insurance agrees to pay for, is undergoing its most significant overhaul in ten years. Due to the new financial liabilities of the Inflation Reduction Act, expensive brand-name medications are being dropped in favor of cheaper alternatives from insurance providers’ lists.
Notably, this year’s cuts aren’t limited to lesser-known medications. They are impacting household brand names that have been a cornerstone of medicine cabinets for years. If your doctor prescribes one of these well-known brands, you may find your claim rejected at the pharmacy counter, leading to the full cash price payment or a scramble for a new prescription. Here are six familiar brand-name drugs being removed from Medicare formularies in 2026 and the economic reasons behind their omission.
Flovent HFA: The Asthma Standard
For years, Flovent has been viewed as the gold standard inhaler for managing asthma and COPD. However, the manufacturer, GSK, discontinued the branded version of Flovent and replaced it with an “authorized generic.” This change has caused confusion among patients as many Medicare Part D plans have either delayed adding the new generic to their formularies or put it in a non-preferred tier.
The Asthma and Allergy Foundation of America has highlighted that this has left patients in a coverage gap where their familiar brand is gone, but the generic substitute is not yet covered by their plan. This often results in seniors having to switch to different inhaler brands like Arnuity or Qvar, necessitating new doctor visits and potential side effect monitoring.
Humira: The Arthritis Giant
Humira’s reign as the world’s best-selling drug has essentially ended in the Medicare market. With the introduction of multiple FDA-approved biosimilars such as Hyrimoz, Cyltezo, and Hadlima, Part D plans are quickly removing the costly brand-name Humira from their preferred lists. In 2026, insurers like CVS Health (Caremark) have explicitly excluded Humira from major commercial and Medicare formularies, favoring cheaper biosimilars instead.
As a result, rheumatoid arthritis patients refilling a prescription for branded Humira may likely encounter a “Non-Formulary” rejection. They will need to switch to the plan’s preferred biosimilar—which is clinically equivalent but uses a different injection device—or pay thousands of dollars out of pocket.
Eliquis vs. Xarelto: The Blood Thinner Battle
For many years, Medicare plans have often covered both leading anticoagulants, Eliquis and Xarelto, leaving the choice to patients and doctors. However, Medicare Price Negotiation pressures in 2026 have forced plans to pick one. To secure improved rebates, many insurers have signed “exclusive” contracts with just one manufacturer.
This move means that a plan might cover Xarelto while entirely dropping Eliquis, or vice versa. As per KFF analysis of Part D plan formularies, this “winner-take-all” formulary design is becoming the standard. Patients stabilized on the “losing” drug are receiving letters forcing them to switch to the competitor drug due to non-medical reasons, causing a risky disruption for those managing stroke risks.
Lantus and Levemir: The Legacy Insulins
While the $35 monthly copay cap for insulin is a significant relief for seniors, it comes with a caveat: it only applies to the insulins on your plan’s formulary. To maximize profits under this cap, plans are narrowing their lists. Many have dropped “legacy” brand names like Lantus or Levemir in favor of particular biosimilars (like Semglee or Basaglar) or unbranded biologics.
This move means that if your plan has dropped Lantus, the $35 cap no longer applies to it, and you would pay full price. The capped price only applies if you switch to the specific insulin product chosen by your plan. This change has led to widespread confusion at pharmacy counters, where seniors wrongly assume all insulin is capped, only to find out their specific brand is now full price.
Ozempic/Mounjaro: The “Off-Label” GLP-1s
There has been a significant clampdown on weight loss drugs. While Ozempic and Mounjaro are covered for Type 2 Diabetes, plans are aggressively removing them from formularies for those without a strict diabetes diagnosis code. In the past, doctors could sometimes get these approved for “Pre-Diabetes” or metabolic syndrome.
Insurers now use AI-driven audits to retroactively check patient history. If your medical record does not show a history of A1C levels confirming diabetes, the drug is removed from your coverage. As noted in recent payer coverage updates, this technically falls under a “utilization management” drop. However, the result is the same: the drug is no longer covered for you, despite your history of taking it.
Restasis: The Eye Drop Staple
Restasis, the long-standing single option for chronic dry eye, commanded a premium price and Tier 3 status. However, with the release of the generic cyclosporine and the competitor brand Xiidra, Medicare plans are cutting off the costly brand-name Restasis.
Many formularies have moved brand-name Restasis to the “Non-Formulary” or “Exclusion” list, directing patients to try the generic version first. Despite the active ingredient being the same, patients often complain that the generic drop mechanism or consistency feels different. Regardless of preference, the brand name is now a luxury item that most Part D plans are unwilling to subsidize.
Faced With Dropped Medication? Appeal!
If your medication has been dropped, resist automatically reaching for your credit card. First, call your doctor and ask if a “Therapeutic Interchange” to the covered alternative is safe for you. In many instances, the generic or competitor drug works perfectly fine. However, if you have a specific medical reason why you must stay on the dropped brand—such as an allergic reaction to the alternative—you have the right to file a “Formulary Exception Request.” This is a formal appeal asking the plan to cover the drug as a medical necessity. It requires paperwork from your doctor but, if approved, can lock in your coverage for the rest of the year.
Did your Medicare plan drop your blood thinner or insulin this year? Leave a comment below—let us know which brands are disappearing from your coverage!
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