MMO: 10/28/25 Broker Update

On October 28, 2025

Pharmacy Benefit Changes Effective Jan. 1, 2026; Member Notifications Planned

Topic: Product News | Companies: Medical Mutual, Mutual Health Services | Segment: Individual, Small Group (1-50), 51-99, 100+, MEWA

Several changes to members’ pharmacy benefits will be effective Jan. 1, 2026. These changes are listed below.

2026 Formularies with Express Scripts (ESI)

Updated formularies reflecting changes that will be effective Jan. 1, 2026 can now be viewed. These changes will have minimal impact on groups and members. Letters will be sent 60 days in advance to inform members of any steps that need to be taken. Medications on the lists below will change categories as noted (e.g., moving cost-share tiers, being excluded from coverage):

The full 2026 guidebooks for these formularies can be found here:

Notable updates to the 2026 formularies include:

Formulary Changes Involving Stelara: Effective Jan. 1, 2026, for new utilizers only, the brand name drug Stelara will be excluded from the National Preferred Formulary and will be non-preferred with a step-therapy requirement for the Basic Plus and ACA Advantage formularies. The biosimilar alternative, Yesintek, will be preferred. Current utilizers will be grandfathered until July 1, 2026 and will be notified of its impending exclusion with letters mailing by May of 2026.
Preferred Continuous Glucose Monitoring Systems: The company Lifescan, a manufacturer of one-touch diabetes supplies, has filed for bankruptcy and will be moved to Medical Mutual’s block list. As of Oct. 13, 2025, Lifescan products are excluded for new utilizers. Current utilizers may continue using Lifescan products through Dec. 31, 2025. Notifications will be sent to these impacted members with instructions for switching to a preferred product manufactured by Abbott (FreeStyle) or Trividia (TrueMetrix, TrueTrack). ESI will also provide a voucher for getting a new product. See the two vouchers listed below for more information:
- FreeStyle
- TRUE METRIX

SaveOnSP Updates

Various updates have been made to the drug lists for the SaveOnSP program beginning Jan. 1, 2026, SaveOnSP now includes more than 400 specialty medicines filled through Accredo, Gentry, and University Hospitals. MetroHealth pharmacy is also able to fill SaveOnSP prescriptions for CLE-Care groups.

The drug lists have been updated to include these changes:

Standard Plus Brand and Generic Medication List Update

On an annual basis, Medical Mutual works with ESI to identify medications that can bypass the deductible for groups with health savings accounts. Updated versions of the Standard Plus non-HCR preventive lists are now available for 2026.

Updated Value of Integration (Advanced Pharmacy Management Program) Brochure

This brochure, which illustrates to groups how integration of medical and pharmacy benefits can result in significant cost savings, has been updated with new statistics. The brochure can be viewed here.

MedMutual Employer Lunch and Learns

Topic: Company News | Companies: Medical Mutual, Paramount, Mutual Health Services | Segment: Small Group (1-50), 51-99, 100+, MEWA

Introducing MedMutual Employer Lunch & Learns

Medical Mutual is pleased to introduce MedMutual Employer Lunch & Learns, a new webinar series designed to provide employer groups with timely and relevant insights on topics that impact their workforce. Each session will be thirty minutes and held every other month. Subject matter experts will lead discussions on issues that matter most to employers and their employees. The purpose is to educate and inform, not to promote or sell.

First Session: Understanding Depression

Medical Mutual’s inaugural event, presented in partnership with ESI Employee Assistance Program (EAP), will take place on November 19 at 12:00 p.m. and will focus on Understanding Depression. It’s intended solely for educational purposes and does not replace professional medical advice.

This session will cover:

Common symptoms and risk factors
Treatment options
Guidance on when to seek professional help

Medical Mutual will e-mail invitations to group officials on Thursday, October 30.

Please feel free to share this information with your groups and encourage attendance. The registration link can be found here.

2026 Small Group ACA Marketing Materials Available

Topic: Product Updates | Segment: Small Group (1-50)

All Small Group ACA plan grids have been updated for the 2026 Small Group ACA rollout and quoting is now available.

All 2026 materials are available to download via the links below.

Updates to MyParamount Portal: New Password Required

Topic: Company News | Companies: Paramount | Segment: Individual, Medicare, Small Group (1-50), 51-99, 100+

Medical Mutual is excited to continue integrating Paramount into its processes and technology. While they work on making systems easier to navigate for their internal teams, members and broker partners, they’d like to make you aware of a small disruption to the external-facing MyParamount Portal.

Updates were made to the MyParamount Portal from 8 a.m. on Oct. 25 until 7 a.m. on Oct. 27. At their next login, Paramount Members will need to reset their password and will see a new layout on the login page, but the updates will not affect the app’s location, installation or any other aspects. See below.

Q: Do credentials change as part of the update?

A: Yes. User accounts will need to reset password on first login with current credentials. They will then be redirected to “Forgot Password” steps. Some users will be notified to re-register.

Q: Will the look and feel of the app change?

A: Yes, the login page has an updated look.

Next steps for Paramount members:

Members will see this message on the login page: “Attention Members and Providers: Due to an upcoming update to the MyParamount login page, when you log in to your account after Oct. 27, 2025, you will be navigated to the Forgot Password page where you will need to reset your password. At the time of the update, some account users may receive an email to re-register with a new username, so please check your inbox.”

If you receive questions from members, ask them to follow the steps in the grid or reach out to your ExpressLink representative.

Please reach out to your ExpressLink representative with any questions.