{"documentId":"1E7FormularyWinLossLog2026_mno987PqRsTuVwXyZ1234","title":"Formulary Win/Loss Log — YTD 2026","revisionId":"rev-1E7Formulary","body":{"content":[{"sectionBreak":{"sectionStyle":{"columnSeparatorStyle":"NONE","contentDirection":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":35,"textRun":{"content":"Formulary Win/Loss Log — YTD 2026\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"TITLE","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":195,"textRun":{"content":"Maintained by the Payer Account Lead. Updated within 24 hours of any tier-status change at a tracked plan. Distribution: Market Access leadership, Launch Lead, Sales Operations, KAM leadership.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":9,"textRun":{"content":"Summary\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":432,"textRun":{"content":"Through May 15, 2026, the Zenvara formulary book reflects 18 wins (tier 2 preferred or better) across 23.5M covered lives, two losses (Humana Gold Plus, BCBS Minnesota) and one step-edit imposition (Florida Medicaid AHCA) attributed to competitor X. Net change YTD: +9.9M lives versus end of 2025 baseline. The single largest move this YTD is the Cigna Open Access Plus win confirmed May 14 (+14.1M lives, effective July 1, 2026).\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":27,"textRun":{"content":"This week (Week 19, 2026)\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":346,"textRun":{"content":"WIN — Cigna Open Access Plus: Tier 3 preferred with prior authorization only. Effective July 1, 2026. Lives impacted: +14.1M commercial. Confirmed by Aisha in #market-access-payers Thursday afternoon. KAM account: Karen Holmes. Contracting terms: standard manufacturer rebate of 18%, target-discount agreement on net price erosion through 2027.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":416,"textRun":{"content":"LOSS — Florida Medicaid AHCA (Florida Agency for Health Care Administration): Zenvara moved from preferred to non-preferred on the May 11 Preferred Drug List refresh. Step-edit through competitor X imposed. Lives impacted: -4.2M Medicaid. State PDL refresh landed on Sunday and was not registered internally until the following Friday — a process gap that has been escalated to internal monitoring for remediation.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":27,"textRun":{"content":"Net week 19: +9.9M lives.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":19,"textRun":{"content":"All wins YTD 2026\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":93,"textRun":{"content":"Cigna Open Access Plus (May 14): tier 3 preferred, PA only. +14.1M commercial. (This week.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":112,"textRun":{"content":"Express Scripts 2026 NPF (May 5): tier 3 preferred with PA. +12.0M lives across all books that use ESI as PBM.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":134,"textRun":{"content":"Aetna Medicare Advantage (Apr 28): preferred tier with PA. +3.4M Medicare. (Recovery from earlier provisional non-formulary status.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":99,"textRun":{"content":"BlueCross BlueShield Federal Employee Program (Apr 15): preferred tier with PA. +5.3M commercial.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":68,"textRun":{"content":"Highmark BCBS (Apr 8): tier 3 preferred with PA. +6.1M commercial.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":82,"textRun":{"content":"UHC Community Plan (Apr 1): preferred tier with PA. +7.2M Medicaid Managed Care.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":118,"textRun":{"content":"HCSC (BCBS Illinois + Texas + Oklahoma + Montana + New Mexico) (Mar 22): tier 3 preferred with PA. +7.4M commercial.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":106,"textRun":{"content":"Anthem BCBS PPO (Mar 15): tier 3 with PA + ST. +22.4M commercial. (Largest single win YTD before Cigna.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":67,"textRun":{"content":"Florida Blue (Mar 8): tier 3 preferred with PA. +5.0M commercial.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":177,"textRun":{"content":"Kaiser Permanente (Mar 1): preferred tier with PA. +12.6M commercial. (Notable: Kaiser is integrated; placement is on the Kaiser formulary directly rather than through a PBM.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":77,"textRun":{"content":"Centene Ambetter (Feb 22): tier 3 preferred with PA. +3.8M Health Exchange.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":113,"textRun":{"content":"UnitedHealthcare Choice Plus PPO (Feb 15): tier 3 preferred with PA. +27.5M commercial. (Largest YTD by lives.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":71,"textRun":{"content":"Centene WellCare (Feb 8): preferred Medicare with PA. +4.5M Medicare.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":89,"textRun":{"content":"CVS Caremark SilverScript (Jan 30): preferred Medicare PDP with PA. +5.7M Medicare PDP.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":88,"textRun":{"content":"Express Scripts Medicare (Jan 22): preferred Medicare PDP with PA. +4.1M Medicare PDP.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":235,"textRun":{"content":"Aetna Open Access PPO (Jan 15): tier 4 with step-therapy through pembrolizumab. +17.2M commercial. (Note: classified as a win because Aetna is on the formulary, but the step-therapy through pembrolizumab limits prescribing autonomy.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":85,"textRun":{"content":"Molina Healthcare (Jan 8): preferred Medicaid Managed Care with PA. +5.1M Medicaid.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":87,"textRun":{"content":"Aetna Better Health (Jan 4): preferred Medicaid Managed Care with PA. +2.9M Medicaid.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":21,"textRun":{"content":"All losses YTD 2026\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":133,"textRun":{"content":"Florida Medicaid AHCA (May 11): moved from preferred to non-preferred; step-edit through competitor X. -4.2M Medicaid. (This week.)\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":97,"textRun":{"content":"Humana Gold Plus HMO (Apr 15): non-formulary; exception process only. -8.9M Medicare Advantage.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":136,"textRun":{"content":"BCBS Minnesota (Mar 22): step-therapy required through competitor X. -4.6M commercial. Filed an appeal in late March; outcome pending.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":32,"textRun":{"content":"Watch items (potential losses)\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":196,"textRun":{"content":"Express Scripts 2027 NPF refresh: due to be finalized August 2026 for 2027 effective date. Probability of step-edit imposition: estimated 70%. Estimated impact: -15M to -22M effective lives YoY.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":197,"textRun":{"content":"Anthem closed-formulary states: probability that Anthem moves to closed formulary in 4 BCBS-aligned states (IN, KY, OH, VA) in 2027 cycle: estimated 60%. Estimated impact: -11M to -14M lives YoY.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":178,"textRun":{"content":"CVS Caremark step-edit reinforcement: probability that CVS strengthens the existing step-edit in the 2027 NPF: estimated 40%. Estimated impact: -8M to -12M effective lives YoY.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":15,"textRun":{"content":"Process notes\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":286,"textRun":{"content":"All wins and losses are reflected in the next MMIT digest (typically 5-15 day lag from the formal decision). Internal tracking should not rely on MMIT alone; the Payer Account Lead's direct relationships with PBM contracting and individual plan formulary teams are the primary source.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":283,"textRun":{"content":"State Medicaid PDL refreshes are monitored weekly via Florida AHCA, Texas HHSC, California DHCS, New York DOH, Ohio DODD, and Pennsylvania DHS published feeds. The Florida miss this week prompted a process review; we will switch to daily monitoring on Sundays for the next quarter.\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":18,"textRun":{"content":"Cross-references\n","textStyle":{"bold":true}}}],"paragraphStyle":{"namedStyleType":"HEADING_2","direction":"LEFT_TO_RIGHT"}}},{"paragraph":{"elements":[{"startIndex":1,"endIndex":116,"textRun":{"content":"2026 US Payer Landscape Brief (1D2…), Weekly Launch Tracker WK19 (1A2…), Payer Objection Handling Playbook (1F1…).\n","textStyle":{}}}],"paragraphStyle":{"namedStyleType":"NORMAL_TEXT","direction":"LEFT_TO_RIGHT"}}}]},"documentStyle":{"pageNumberStart":1,"marginTop":{"magnitude":72,"unit":"PT"},"marginBottom":{"magnitude":72,"unit":"PT"},"marginLeft":{"magnitude":72,"unit":"PT"},"marginRight":{"magnitude":72,"unit":"PT"},"pageSize":{"height":{"magnitude":792,"unit":"PT"},"width":{"magnitude":612,"unit":"PT"}}},"namedStyles":{"styles":[{"namedStyleType":"NORMAL_TEXT","textStyle":{"fontSize":{"magnitude":11,"unit":"PT"}}},{"namedStyleType":"TITLE","textStyle":{"fontSize":{"magnitude":26,"unit":"PT"},"bold":true}},{"namedStyleType":"HEADING_1","textStyle":{"fontSize":{"magnitude":20,"unit":"PT"},"bold":true}},{"namedStyleType":"HEADING_2","textStyle":{"fontSize":{"magnitude":16,"unit":"PT"},"bold":true}}]},"lists":{},"inlineObjects":{},"headers":{},"footers":{},"footnotes":{},"suggestionsViewMode":"DEFAULT_FOR_CURRENT_ACCESS"}