By June 15, 2026: Billing and clinical teams must complete the following updates: (1) Update billing software to remove standalone prior authorization policies for Adbry, Opzelura, Phesgo, Trastuzumab, and Lotilaner, and redirect claims to consolidated policies (Targeted Immune Modulators, Topical Skin Disease Agents, Oncology Agents, and Medical Necessity respectively); (2) Add 16 new drugs to the commercial formulary with appropriate tier assignments and requirements (Aukelso, Desmoda, Loargys, Myqorzo, Ontralfy, Orladeyo, Rezenopy, Rizafilm, Sdamlo, Shingrix, Sogroya, Vibrique, Wegovy, Yuvezzi, Yuviwel, Zepbound, Zycubo); (3) Configure system to enforce prior authorization, step therapy, quantity limits, specialty pharmacy routing, and limited access flags for applicable new drugs; (4) For state-based plans (OR/ID/MT/WA): Remove Lotilaner solution from formulary with alternative ivermectin options; remove Xgeva, Wyost, Osenvelt, Bomnytra, and Bilprevda from pharmacy benefit and update to medical benefit with prior authorization; (5) Update encounter forms and clinical decision support to reflect new coverage criteria for ERT for Gaucher Disease, Immune Globulin, Inebilizumab-cdon, Palynziq, Rituximab, Subcutaneous Immune Globulin, and Xgeva; (6) Train front desk, billing, and clinical staff on new requirements before June 22, 2026. Failure to implement changes will result in claim denials for non-compliant prescriptions, delayed processing for missing prior authorizations, and patient confusion regarding coverage. Providers must request prior authorization before dispensing when required.