By October 21, 2025: (1) Billing team must audit all active prescriptions in patient charts to identify medications affected by this policy change—specifically those listed in the 'Removed from Formulary' section (Emend, Nicotrol, AK-Poly-Bac, Aminosyn variants, Tyvaso, Aldactazide, and 50+ others); (2) Update billing software to reflect new prior authorization requirements for medications moving to 'Add Medical Necessity' category (Aptiom, Brillinta, Entresto, Nityr, Orfadin); (3) For national commercial plans, update system to apply new tier placements and specialty pharmacy (SP) restrictions for 40+ new formulary additions (Andembry, Bomyntra, Conexxence, Ekterly, Ibtrozi, Imuldosa, Nilotinib D-Tartrate, Osenvelt, Ryzneuta, Stoboclo, Zelsuvmi, and others); (4) For PacificSource state-based plans (OR, ID, MT, WA), apply different tier levels (tier 3-4 vs tier 0-3 nationally) and note that Brillinta, Entresto, Nityr, and Orfadin are REMOVED from state formularies with alternatives specified; (5) Clinical staff must review changed prior auth criteria for high-volume drugs (Dupilumab, Mepolizumab, Denosumab, Hepatitis C DAA, Hereditary Angioedema agents) and update ordering workflows to ensure new required medical information is collected; (6) Front desk and patient service teams must contact all patients with prescriptions for removed medications to coordinate alternative coverage options; (7) Verify quantity limits and access restrictions (limited access, quantity vs. time limits) are accurately configured in billing system for new additions. Failure to implement these changes will result in claim denials, authorization delays, and patient access disruptions beginning October 22, 2025.