By August 15, 2026: Billing team must complete the following: (1) Update billing software to require prior authorization for all 20 newly added drugs listed in the formulary additions, with specific attention to those marked with 'SP' (specialty pharmacy), 'limited access', and 'quantity limit'; (2) Program quantity limits in the claims system for drugs including Auvelity, Breztri Aerosphere, Foundayo, Icotyde, Jakafi XR, Kygevvi, Lerechol, Nintedanib, Relgaabi, Saphnelo, Wainua, Wegovy HD, and Zolymbus; (3) Remove Ocaliva from the commercial formulary; (4) Update formulary tier assignments in billing and patient-facing systems (e.g., Idvynso tier 2, all others tier 3 unless specified); (5) For state-based plans (OR, ID, MT, WA): implement different tier assignments (Nintedanib moves to tier 4), remove Farxiga, Ofev, and Xigduo XR, and remove medical necessity from dapagliflozin products; (6) Configure medical necessity prior authorization for new drugs and add medical necessity to Farxiga, Ofev, and Xigduo XR (commercial only); (7) Remove medical necessity from dapagliflozin tablet and dapagliflozin-metformin ER tablet (commercial); (8) Alert providers and prior auth staff about updated clinical criteria for CFTR modulators, ETA receptor antagonists, Evkeeza, Juxtapid, Evolocumab, hereditary angioedema treatments, Inclisiran, oncology agents, Sotatercept-CSRK, and Tzield; (9) Update encounter forms and prior auth templates to reflect new age restrictions and medical information requirements. Providers should obtain prior authorization for all newly formulary-added medications before dispensing. Failure to implement these changes will result in claim denials and patient access delays.