If you got a letter saying Dupixent won’t be covered in 2026, you’re probably starting to look into what the other covered options are – and which ones might work for you. Let’s break it down. In this article, we’ll deep dive into the FEP Blue formulary – what’s covered and not, what it means if you switch, and where the fine print matters (like age limits, boxed warnings, and off-label gaps). 

And remember – you don’t have to just switch. If Dupixent is working for you, especially if some of these alternatives don’t seem like a fit, you have the right to request an exception and get Dupixent covered.

First off - what exactly is on the FEP Blue Formulary for 2026?

Formularies are long and complicated. The FEP Blue formulary for 2026 clocks in at 175 pages – whew! Let’s skip to the important stuff. 

Before we go further – this isn’t medical advice. We’re here to help you understand your formulary and what it means, and you should always speak to your doctor before making any medication adjustments or changes.

Excluded drugs - Dupixent‍

Here’s what the formulary says about Dupixent, and the options available.

The important part here: Preferred options may vary by indication. And what’s indicated for Dupixent has a lot of variation. Dupixent is an antibody that that binds IL-4 receptor-alpha (IL-4Rα), which is the shared “docking station” for two key inflammatory messengers, IL-4 and IL-13. This means it can impact the type of inflammation that drives many different diseases – from reducing esophageal stiffness in eosinophilic esophagitis to turning down the itch signal in prurigo nodularis.

Why it’s relevant? The alternatives may work in a different way and for some indications, not at all. For example, Fasenra might be a good substitute for Dupixent for a patient with eosinophilic asthma as it can similarly reduce flares, but it wouldn’t be effective for someone with eczema – Fasenra doesn’t work on the pathways related to itch, skin barrier, or other inflammatory eczema symptoms.

What’s covered for which indication?

Don’t worry – you don’t have to dig through 175 pages of a formulary PDF to find out what you can take for what. Here are which alternatives are FDA-approved for each condition:

Not sure what these alternatives mean for you? Let’s break it down one by one – find your condition below to learn more about the specific alternatives and what to consider. 

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Atopic Dermatitis (Eczema)

What Dupixent alternatives are covered by FEP Blue for Asthma?

• Adbry (tralokinumab): This IL-13–only antibody is FDA-approved for patients over the age of 12 with moderate-to-severe AD. 
• Ebglyss (lebrikizumab): Another IL-13–only antibody; also FDA-approved for ages 12 and up as well as over 40 kg (88 lbs). 
• Rinvoq (upadacitinib): Oral JAK-1 inhibitor that is FDA-approved for AD in adults and adolescents over 12 (weight-based). Rinvoq carries boxed warnings including serious infections, malignancy, MACE, thrombosis.

How they differ from Dupixent (why it matters):

• Efficacy: Dupixent blocks IL-4 and IL-13 pathways, where Adbry/Ebglyss blocks only IL-13 – that narrower target can matter for some patients’ itch/inflammation profiles, meaning Adbry/Ebglyss may be less effective.
• Side effects: Rinvoq is a systemic immunomodulator with boxed warnings; many patients do well on it, but the risk profile and monitoring requirements are higher to avoid potentially serious complications.

Formulary flags:

• Kids under 12: There is no FDA-approved systemic alternative to Dupixent in this age group; Adbry, Ebglyss, and Rinvoq are all 12+. If your under-12 child is covered by FEP Blue and is taking Dupixent, there is no approved alternative for them to switch to. An appeal for Dupixent coverage will highlight this to show you should stay covered.
• Risk: Rinvoq’s boxed warning applies across indications; discuss risks and monitoring with your prescriber before switching. If you don’t want to risk these potential side effects by switching, you can make that argument in your appeal.

Documentation commonly required for coverage approval:

• Failure of or intolerance to topical steroids or calcineurin inhibitors (like tacrolimus)
• Baseline severity score (EASI, vIGA, POEM, or SCORAD)
• If you're currently on Dupixent: improvement shown by severity scores
• Evidence that you've been adherent to treatment

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Asthma (type-2/eosinophilic or allergic)

What Dupixent alternatives are covered by FEP Blue for Asthma?

• Fasenra (benralizumab): This IL-5Rα antibody depletes eosinophils to help reduce flares in certain types of asthma. It’s FDA-approved for eosinophilic asthma for patients over the age of 6.
• Nucala (mepolizumab): Similar to Fasenra, this IL-5 antibody also lowers eosinophils. It’s FDA-approved for eosinophilic asthma eosinophilic asthma for patients over the age of 6.
• Xolair (omalizumab): An Anti-IgE antibody that’s FDA-approved for allergic asthma with positive allergy testing, in patients over the age of 6.
  

How they differ from Dupixent (why it matters):

• Mechanism targeting: Fasenra/Nucala work best when eosinophils drive your asthma. Xolair helps if you have allergic asthma with high IgE/sensitization. Dupixent, on the other hand, blocks IL-4/IL-13 (type-2 inflammation) and can help both allergic and eosinophilic patterns, including patients who are oral-steroid dependent. So if your asthma control on Dupixent is tied to type-2 inflammation, a switch to one of these alternatives isn’t always comparable.
  Cross-condition control: If you have eczema or nasal polyps in conjunction with Asthma, Dupixent treats those too. IL-5 or anti-IgE drugs won’t help the skin or polyps, meaning you may have to try multiple drugs concurrently to address more symptoms.

Formulary flags:

• No “one-size-fits-all”: If you’re not allergic (for Xolair) or not eosinophilic (for IL-5/IL-5R drugs), these switches may be a poor fit – we can highlight this in your appeal to stay on Dupixent.
• Anaphylaxis warning (Xolair): Carries a boxed warning and may require post-injection observation. Some providers prefer Dupixent for a lower risk option.

Documentation commonly required for coverage approval:

• Eosinophil counts showing eosinophilic asthma, OR need for daily oral steroids
• History of asthma exacerbations or hospitalizations in the past year
• Failure of inhaled corticosteroids combined with long-acting bronchodilators
• If you're currently on Dupixent: fewer exacerbations or symptom improvement

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Chronic Rhinosinusitis with Nasal Polyps (CRSwNP) 

What Dupixent alternatives are covered by FEP Blue for Nasal Polyps?

• Nucala (mepolizumab): This IL-5 antibody reduces eosinophils, which can help with shrinking polyps, congestion, and reducing flares. It’s FDA approved for adults (18+)
• Xolair (omalizumab): Anti-IgE antibody that reduces edema and mucus to improve nasal polyp symptoms. It’s also FDA-approved for adults (18+)
  

How they differ from Dupixent (why it matters):

• Pathway targeting: Dupixent (IL-4/IL-13) directly targets type-2 signaling in polyp disease; Nucala focuses on eosinophils; Xolair targets allergic IgE pathways. If you’re non-allergic or your eosinophils aren’t elevated, your response to those alternatives may be weaker than to Dupixent.
• Symptom bundle: Dupixent often improves smell/taste and congestion in patients with type-2 inflammation patterns; results with IL-5/IgE agents can depend on the root cause of your symptoms.

Formulary flags:

• Allergy requirement (Xolair): Typically needs proof of allergic sensitization.
• Cross-condition control: If Dupixent is stabilizing both your polyps and comorbid eczema/asthma, a switch may help sinuses but not skin/airways the same way. This is important when weighing overall disease control.
• Anaphylaxis warning (Xolair) and phenotype mismatch (for either alternative) are legitimate concerns to document – these can help you make your case to stay on Dupixent if it’s working for you.

Documentation commonly required for coverage approval:

• Failure of at least two nasal steroid sprays and one oral steroid course
• Persistent symptoms despite 3+ months of treatment
• If you're currently on Dupixent: symptom improvement

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COPD

What Dupixent alternatives are offered by FEP Blue for COPD?

• Nucala (mepolizumab): This IL-5 antibody reduces eosinophils, which can lower airway inflammation, exacerbations and steroid bursts. It’s FDA approved for adults (18+)

How it differs from Dupixent (why it matters):

• Pathway: Nucala targets IL-5 to lower eosinophils. Dupixent targets IL-4/IL-13, a different part of type-2 inflammation that’s impactful in COPD for some patients. Depending on your biomarker profile and history (ex: frequent flares despite triple inhalers), one may fit better than the other.

Formulary flags:

• Varying mechanisms: Your COPD may be driven by pathways beyond eosinophils, so some patients who respond to Dupixent might not do as well on pure IL-5 blockade like Nucala and vice versa. Without a head-to-head study, it’s hard to know at scale – and if Dupixent is working for you, you shouldn’t have to risk that uncertainty.
• Cross-condition control: If Dupixent is also controlling eczema (AD), EoE, prurigo nodularis or bullous pemphigoid, switching to Nucala won’t cover those diseases. You and your doctor may worry about flares outside the lungs. 

Documentation commonly required for coverage approval:

• Eosinophil counts showing eosinophilic COPD
• Failure of standard COPD medications (inhaled steroids, bronchodilators)
• History of exacerbations despite treatment
• If you're currently on Dupixent: fewer exacerbations or symptom improvement
  

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Chronic Hives / Chronic Spontaneous Urticaria (CSU)

What Dupixent alternatives are offered by FEP Blue for CSU?

• Xolair (omalizumab): An anti-IgE antibody that’s been a long-standing FDA-approved biologic for CSU after antihistamines fail. Approved in patients 12 and up.

How it differs from Dupixent (why it matters):

• Mechanism: Xolair targets IgE, which is the “allergic” part of CSU; Dupixent targets IL-4/IL-13, getting more at the root cause of the reaction. Some patients respond to one pathway but not the other – especially if autoimmunity plays a role.
• Logistics: Xolair dosing differs and sometimes observation is recommended. Response can be rapid or gradual, meaning it might take you some time to get back to a controlled state for your CSU,

Formulary flags:

• Boxed warning for Xolair: Xolair carries a risk of anaphylaxis – it’s important to consider, and you can argue in an appeal that you don’t want to take that risk by switching.
• Kids under 12: There is no FDA-approved systemic alternative to Dupixent in this age group as Xolair is only for 12+. If your under-12 child is covered by FEP Blue and is taking Dupixent, there is no approved alternative for them to switch to. An appeal for Dupixent coverage will highlight this to show you should stay covered.

Documentation commonly required for coverage approval:

• Persistent hives despite trying at least two different antihistamines
• Urticaria Activity Score (UAS) showing severity
• Failure of or intolerance to Xolair (if tried)
• If you're currently on Dupixent: improvement in hives and itching

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Eosinophilic Esophagitis (EoE)

What Dupixent alternatives are covered by FEP Blue for EoE?

• On-label: None equivalent. Dupixent is the only FDA-approved biologic for EoE, meaning that stopping coverage is asking patients to switch to an off-label drug.

Why it matters:

• If Dupixent is working for you, you have a strong case to appeal – and you should. It doesn’t mean the off-label option won’t work for you (as always, discuss in detail with your provider), but you shouldn’t be made to switch off a stable medication that’s working for you – especially to one that hasn’t been approved for your condition.

Documentation commonly required for coverage approval:

• Diagnosis confirmed by endoscopy and biopsy showing elevated eosinophils
• Failure of proton pump inhibitor (PPI) therapy
• If you're currently on Dupixent: symptom improvement

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Prurigo Nodularis 

What Dupixent alternatives are covered by FEP Blue for Prurigo Nodularis?

• On-label: None equivalent. Dupixent is the only FDA-approved biologic for Prurigo Nodularis, meaning that stopping coverage is asking patients to switch to an off-label drug.

Why it matters:

• If Dupixent is working for you, you have a strong case to appeal – and you should. It doesn’t mean the off-label option won’t work for you (as always, discuss in detail with your provider), but you shouldn’t be made to switch off a stable medication that’s working for you – especially to one that hasn’t been approved for your condition.

Documentation commonly required for coverage approval:

• Diagnosis and disease severity
• Failure of phototherapy or conventional systemic treatment
• If you're currently on Dupixent: symptom improvement

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Bullous Pemphigoid 

What Dupixent alternatives are covered by FEP Blue for Bullous Pemphigoid?

• On-label: None equivalent. Dupixent is the only FDA-approved biologic for Bullous Pemphigoid, meaning that stopping coverage is asking patients to switch to an off-label drug. There’s evidence that some steroids and immunosuppressants can help but often have higher systemic risks in older adults – and their safety/efficacy hasn’t been approved for BP. 

Why it matters:

• If Dupixent is working for you, you have a strong case to appeal – and you should. It doesn’t mean the off-label option won’t work for you (as always, discuss in detail with your provider), but you shouldn’t be made to switch off a stable medication that’s working for you – especially to one that hasn’t been approved for your condition.

Documentation commonly required for coverage approval:

• Diagnosis confirmed by biopsy
• Failure of high-potency topical steroids, oral steroids, and/or antibiotics/dapsone
• If you're currently on Dupixent: symptom improvement

So… do I have to switch from Dupixent to something else? 

The short answer: No.

If the “covered alternatives” don’t match your age, diagnosis, phenotype, or safety profile – or you’re stable on Dupixent – you have a strong case to get Dupixent covered again by submitting a formulary exception. 

Under federal rules, members can request exceptions to get clinically appropriate drugs covered, even if they’re not on the plan’s drug list. And if you’re in an active course of treatment, you can request an expedited decision – so you can get back on what works, fast.

How to appeal:

Claimable partners with Dupixent to make it as easy as possible for you to appeal:

• You fill out a short survey to tell us about your medical and personal history.
• We help you make the strongest case: we do the research, draft a personalized letter, include the exact FDA labels, safety language, and clinical precedents that support your diagnosis/phenotype, and get it mailed and faxed where it needs to go.
• For Dupixent appeals, our tool is free to use if you're on a commercial plan (including FEP Blue).

Bottom line

Drug lists can make switches look simple – but specifics about your condition and symptoms, age limits, boxed warnings, and off-label gaps mean the “covered alternative” isn’t always equivalent. 

If Dupixent is the right fit—and especially if you’re stable on it—build the case and appeal. And if you need a hand turning your medical story and the right evidence into a winning exception, Claimable is here to help.

Get started today

“Will not be covered starting January 1, 2026”.

‍If these words look familiar, you’re not alone. In November, thousands of people began receiving formulary change letters or other coverage notices letting them know that a medication that’s working for them – Dupixent – will no longer be covered in the new year.

It can be anxiety-inducing. When you’ve found a treatment that works for you, the thought of changing can be daunting. The good news? You don’t have to. Here’s three steps to take the minute that letter hits your mailbox to keep your coverage, and stay on what works for you.

What to do now (before Dec 31)

1. Ask for a 90-day refill (or “vacation override”).
   Check with your pharmacy to see if you can get your last 2025 refill as a 90-day supply. This can help you stay on treatment while new coverage is reviewed.
   
   
2. Start your formulary exception – and label it “urgent” if you qualify.
   You have a legal right to request an exception when your plan says something won’t be covered. If granted, you’ll be covered again (usually for the full plan year).
   
   If you’re currently taking Dupixent, your request will qualify as “urgent” – meaning that your plan has to make a decision in 72 hours. In practice, we usually find this is closer to 5-7 days, but it’s still the fastest way to get coverage back.
   
   
3. Make a plan with your doctor to request a new approval in January
   If your formulary exception is approved, you’ll be covered in the new year! But to get ahead of things, speak to your doctor now and let them know that you’re in the process of requesting the exception for Dupixent.
   
   If your exception isn’t approved, your doctor or pharmacy will need to submit a new authorization request for Dupixent on January 1 and you can submit another exception request after that happens.  

What happens on Jan 1, 2026

If you haven’t been granted an exception, here’s what you can expect in the new year with a coverage change:

• At the pharmacy: If you try to fill your prescription, the pharmacist will let you know that it’s no longer covered by your plan and see if you want to pay cash price. This can be $3000 or more without coverage, so know the sticker shock is coming and plan ahead.
• If a PA is required: Your prescriber can submit a new Prior Authorization (PA) on or after Jan 1. If the PA or exception is denied, request a pre-service reconsideration.

This is why getting ahead of the timeline matters. You can request the formulary exception the minute the coverage notification letter hits your mailbox – so you can confirm new year coverage before January 1 and skip the pharmacy headaches and PA complexity.   

A realistic timeline to stay covered

Start now

• Request a 90-day supply of your medication.
• Get your formulary exception request submitted (use our step by step guide here, or get started fast by using Claimable)

If your first exception request is denied

• Request a reconsideration of the request. When you make this second request, it’s required to be reviewed by a qualified clinician.
• If you still disagree, you can escalate to have your request reviewed independently by the Office of Personnel & Budget Management.  

On January 1 (if you still don’t have coverage)

• Have your doctor submit a new Prior Authorization for Dupixent.
• If that gets denied, file a new formulary exception request.

Any time after your request has been submitted

• Request your claim file and relevant plan documents – you have a federal right to obtain all the documents they’ve used in making decisions about your request, and you can use this to strengthen your case.  

Need help with the process?

Use our Dupixent appeal tool for the fastest, easiest way to get your exception request drafted and filed. Fast, easy, and free for eligible patients.

If you’re currently taking Dupixent and got a 2026 “not covered” notice, you might be wondering – do I have to switch medications and start all over again? 

The short answer: No. Many people don’t know this, but when insurance denies your meds or asks you to change to something else, you don’t have to just accept a switch. Under federal law as well as FEP Blue’s own policies, you have rights that protect you and can help you get coverage back for the medication that’s working for you.

BCBS Formulary Exception Process
The Formulary Exception process allows members to apply for coverage of a non-covered drug if they have tried and failed the covered drug(s). If the exception is approved, the non-covered drug will be covered.

Let’s break down your essential rights – and how to use them to stay covered.

Your rights overview – what you can ask for:

• Right to request a formulary exception. You (not just your doctor) may ask the plan to cover a non-formulary drug (one that isn’t on their “covered list”) when it’s clinically appropriate. If the exception is granted, typically coverage must be provided to the end of the plan year (not just a one-time fill).
  
• Right to an expedited decision if you’re mid-treatment. If you are already taking the medication or if delay poses a risk of serious harm, the plan must issue an expedited decision on your formulary-exception request within 72 hours when you are undergoing a current course of treatment using a non-formulary drug.
  
• Right to clear notices and to access your file. FEP denial notices must identify what was denied and why, and must provide any policies or criteria used upon request. You are also entitled to review and obtain copies of all materials the plan relied on. We strongly recommend requesting your claim file with every denial to verify the plan’s rationale and proper handling.
  
• Right to reasonable reconsideration timelines. For non-urgent pre-service disputes when you are not already on treatment, you have 6 months to request reconsideration. The plan then generally has 30 days to respond unless you request an urgent/expedited review.
  
• Right to a qualified reviewer. For appeals, FEP must consult a clinician with appropriate training and expertise who was not involved in the initial decision to assess the medical necessity of your treatment.
  
• Right to escalate to OPM (final FEHB review). If the appeal is denied—or the plan does not follow required claims procedures—you may take your case to the U.S. Office of Personnel Management for final administrative review. Expedited formulary-exception requests are typically resolved within 72 hours and may be submitted at the same time as your internal review. Standard OPM reviews generally take 30 days. 

How to use these rights to get covered

The important stuff. Lean on your rights as a member of the plan to hold your insurer accountable – you deserve timely responses, fair determinations, and appropriate coverage. Here’s how to make it happen.

1) Ask for a formulary exception

Tell the Plan you’re appealing the non-coverage notice and requesting a member reconsideration/formulary exception for Dupixent based on medical necessity. 

If you’re currently on Dupixent (or delay could seriously harm you), mark it Urgent—pre-service to trigger the expedited review timeline. 

Follow our step-by-step guide for exactly how to do this – or use Claimable to make it easy.

2) If they reject your exception request, ask for your claim file

You’re entitled to a review that considers everything you submit and – when medical judgment is involved – uses a clinician with relevant expertise who wasn’t part of the original decision. You can also review and copy all relevant materials at no charge.  

3) Escalate to OPM for a final decision

For non-urgent pre-service issues, you have 6 months to request reconsideration; the Plan must decide within 30 days (with defined clocks if it asks you for more info). Urgent pre-service reconsiderations, including for any  are due in 72 hours. If the Plan upholds the denial—or doesn’t follow required processes—you may appeal to OPM. For urgent pre-service claims, you can request simultaneous OPM review.   

What counts as a strong basis to keep Dupixent?

Federal rule §156.122(c) says plans must have a way to get an exception to access clinically appropriate non-formulary drugs; “exigent circumstances” include being in a current course of treatment. 

If you have previously tried alternatives that were failed, were intolerable, are contraindicated, are off-label for your diagnosis/age, or carry unacceptable risks versus your stable response on Dupixent, that’s a compelling medical necessity to document. 

Your notices must be understandable and specific FEP notices (EOBs and adverse determination letters) must identify the claim, list key details (date of service, provider, amount), and inform you that diagnosis/procedure codes are available on request. Use this to pinpoint exactly what the plan relied on – and what evidence to add. 

It sounds a bit complicated – because, frankly, it is. There’s a lot of insurance, legal, and clinical complexity to wade through to get it right. That’s why we’re here.

How to appeal easily and effectively‍

Use Claimable. Our free service for Dupixent will draft your appeal, source the exact regulations and provisions, compile clinical evidence tailored to your condition, and file by fax/mail for you – plus handle your OPM escalation if needed.

If you still want to DIY it – or just understand the nuts-and-bolts steps – dig into our step-by-step FEP Blue appeal guide for Dupixent here.

Sources

• Formulary exception & expedited decision (24h/72h) — 45 C.F.R. § 156.122(c): standard & expedited exception processes, decision deadlines, and duration of coverage.
  
• FEP Blue Standard/Basic 2026 Brochure (official plan rights & timelines) — pre-service decision/reconsideration timelines; simultaneous OPM review for urgent claims; notice and file-access rights; disputed claims process.         

Use your rights - and get covered

You have the right to ask for Dupixent to stay covered now, to get a fast answer if you’re mid-treatment, to a qualified, fair review on a clear timetable, and to a final OPM review if needed. Use those rights so you don’t have to start 2026 on the wrong medicine. We’re here to help make it happen.

Start your appeal now

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