Exhibit_5_Formulary___Network_Disruption.xlsx

This document is a formulary disruption exhibit for commercial pharmacy benefit management (PBM) services submitted to the State of Oklahoma's Employees Group Insurance Division (EGID) through the Office of Management and Enterprise Services (OMES) Central Purchasing division. The exhibit presents a comprehensive drug formulary containing approximately 2,500 medications and pharmaceutical products with their respective National Drug Codes (NDCs), prescription volumes (Rxs), acute or maintenance classifications, and current formulary status. The data range specified is January 1, 2025 through December 31, 2025, utilizing an exclusions-based formulary model. Bidders are required to complete the chart by entering their proposed formulary names and indicating the impact of any formulary changes, categorizing medications as positive (moving from non-formulary to formulary status), negative (moving from formulary to non-formulary status), excluded, or no change. The exhibit requires specification of proposed tier levels (1, 2, 3, or excluded status) and identification of specialty indicators, along with alternative medication suggestions where applicable for any drugs moving to negative or excluded status.

The formulary disruption analysis serves as a critical evaluation tool for assessing the network and coverage implications of each bidder's proposed pharmacy benefits formulary. Current drugs represented in the exhibit span multiple therapeutic categories including cardiovascular agents, diabetes management products, respiratory medications, antibiotics, mental health pharmaceuticals, and specialty drugs such as GLP-1 agonists (Ozempic, Mounjaro) and biologic therapies. The prescription volume data indicates utilization patterns ranging from high-volume generic medications like metformin and lisinopril to specialty pharmaceutical products requiring prior authorization. This formulary document will enable EGID to evaluate bidders' proposed coverage changes and their potential impact on plan members, ensuring continuity of care while optimizing pharmacy benefit costs and identifying any therapeutic alternatives for excluded or restricted medications.