By June 15, 2026: (1) Billing and clinical teams must audit patient medication lists to identify those currently on any of the 40+ newly excluded medications (e.g., Aptiom, Brilinta, Pradaxa, Lyrica, Entresto, Lovenox, Kenalog-10, Nexavar, Tasigna, Victoza, Spiriva, Rytary, Tikosyn, Premarin, Promacta, Korlym, Iressa, and others listed). (2) Pharmacy and clinical staff must proactively contact prescribers and patients to transition to generic formulations or specified alternatives BEFORE July 1 to avoid prior-fill claim denials. (3) Billing system must be updated to flag and require prior authorization for: Arbli (losartan) suspension, Depen (penicillamine) tablets, and Lopressor (metoprolol) solution. (4) Add step therapy requirements in system for: Auryxia, Dymista, Nuvaring (BCBSVT only), Spiriva (BCBSVT only, includes QL), Tiglutik, and Zoryve. (5) Implement quantity limits in billing software for: Albendazole, Biltricide, Emverm, Esbriet, Ivermectin (tablets and Stromectol), Leqembi, Ofev, sodium hyaluronate products, Votrient, and Xdemvy. (6) Update encounter forms and prior authorization templates with new requirements. (7) Brief front desk staff to anticipate patient questions about coverage changes. Failure to implement these changes will result in claim denials, delayed patient access to medications, and potential patient appeals.