January 2026 Preferred Drug List Changes and Other Pharmacy PolicyJanuary 6, 2026: This Update has been revised since its original publication. Revised information appears in red text on pages 10, 29, and 33-34.

By December 31, 2025: (1) Billing and pharmacy teams must obtain and review Attachment A to identify all drugs changing from preferred to non-preferred status on the PDL. (2) Update billing system rules to require prior authorization submission for all newly non-preferred drugs effective January 1, 2026. (3) Train pharmacy staff on new PA form F-03412 (01/2026) for Blujepa and Orlynvah submissions; ensure prescribers receive copies of this form. (4) Review Attachment B to identify all revised PA forms and update form inventory in billing software and EMR systems. (5) Update internal provider communication materials to notify prescribers of PDL status changes and direct them to submit completed PA/PDL forms to pharmacies (not directly to ForwardHealth). (6) Configure system to apply new clinical PA criteria for Blujepa and Orlynvah: female members only, FDA-compliant age/weight, uncomplicated UTI only, alternative oral antibiotic deemed inappropriate, approval limited to 5 days. (7) Ensure PA requests route through STAT-PA system, Portal, fax, or mail as instructed. Failure to obtain prior authorization for non-preferred drugs will result in claim denials under Wisconsin Medicaid, BadgerCare Plus, and SeniorCare programs.