Dimensions Newsletter | Fall 2026

Prepare Now for Respiratory Virus Season

As fall approaches, now is the ideal time to prepare for respiratory virus season. The "Triple Threat" of influenza (flu), COVID-19, and RSV (respiratory syncytial virus) can lead to serious illness, missed work or school days, and costly emergency room visits.

To maximize protection throughout the coming months, talk with your health care provider or pharmacist about the best timing for your vaccinations this fall. In many cases, flu and COVID-19 vaccines can be administered during the same visit, while eligible adults may also benefit from RSV vaccination.

PBDRx Coverage Supports Preventive Care

To support our members during the 2026-2027 respiratory virus season, Pharmacy Benefit Dimensions (PBDRx) continues to offer valuable coverage options designed to make preventive care more affordable.

In August 2026, the U.S. Food and Drug Administration (FDA) approved mFLUSIVA® (influenza vaccine, mRNA) for the prevention of influenza subtypes A and B in adults ages 50 and older.

The new mRNA flu vaccine is available to members at $0 cost when administered at a network pharmacy, making it easier than ever to get protected.

Flu vaccination continues to be recommended for adults and children as young as 6 months of age.

In New York, pharmacists can administer flu vaccines to adults and children ages 2 years and older. Parents should take children younger than age 2 to their pediatrician to receive the flu vaccine.

Key Facts About the Flu Vaccine

• October is the ideal time to receive your annual flu vaccine.
• It takes approximately two weeks after vaccination for protection to develop.
• Protection generally lasts about six months.
• Flu vaccine effectiveness varies each season but can significantly reduce the risk of serious illness and hospitalization.
• Children ages 6 months through 8 years who are receiving a flu vaccine for the first time may require two doses administered four weeks apart. Older children and those previously vaccinated typically need only one annual dose.

Expanded Access to COVID-19  Post Exposure Prevention

Beginning October 1, 2026, a new drug for post exposure prevention of COVID-19, called Xocova®, will be covered for adults and children ages 12 years and older as a Tier 3 medication on the PBDRx formulary, helping ensure members have access to important treatment options when they need them most. There is a quantity limit of 4 treatment courses per year.

More About the RSV Vaccine

An RSV vaccine is administered as a single dose and is recommended for:

• Adults ages 75 and older
• Adults ages 50 to 74 with chronic heart or lung disease, weakened immune systems, or other high-risk conditions
• Pregnant women between 32 and 36 weeks of gestation

The RSV vaccine is currently a one-time lifetime dose and is not an annual vaccination.

Understanding the Symptoms

The symptoms of flu, COVID-19, and RSV often overlap, making it difficult to tell the difference without testing. Common symptoms include:

• Fever or chills
• Cough
• Runny nose
• Fatigue
• Headache
• Shortness of breath or difficulty breathing
• Muscle or body aches

Protect Yourself and Your Family This Season

Talk with your health care provider or pharmacist today to determine which vaccines are right for you and when to schedule them. Taking action now can help protect you, your family, and your community throughout the respiratory virus season.

The fall is an ideal time to move your prescriptions to mail-order delivery. Switching now will help you avoid bad winter weather, icy roads, and holiday shipping crunches that can delay your trip to the pharmacy or cause extra stress in your day.

Ensuring you have a 90-day supply of chronic or maintenance medications (drugs you take regularly for conditions like blood pressure or cholesterol), when appropriate and covered under your prescription plan, can help you avoid a trip to a crowded retail pharmacy during peak cold, flu, and respiratory illness season.

As a Pharmacy Benefit Dimensions (PBDRx) member (if your benefit covers mail order), you can get a 90-day supply of maintenance medication delivered to your door at no extra cost.

Depending on the prescription drug benefit plan provided by your employer, you may register with one of two convenient mail-order options — Wegmans Mail Order Pharmacy Services or ProAct Mail Order Pharmacy Services — to receive your medication via mail order.

Why Mail Order is Right for You

Participating in PBDRX’s mail order service will save you a trip to the pharmacy and may reduce your copay costs as compared to a 30-day supply (depending on your plan). Simply put – less hassle, potentially lower costs.

To enroll in PBDRX’s mail order service, have your member ID card handy and follow the steps below:

1. Request a 90-day prescription from your provider.
2. Register for mail order services by phone: 
   • Wegmans: 1-888-205-8573 or TTY/TDD: 1-877-409-8711
   • ProAct: 1-888-425-3301; 1-877-635-9545 or TTY/TDD: 711
   • Members may also enroll in ProAct’s mail order services online at www.proactpharmacyservicespbd.com.
3. Pay your copayment. Both pharmacies accept most major credit and debit cards.
4. Receive your medication within two weeks. Express shipping is available for an additional charge. If you have questions about the status of your mail order prescription, please contact the mail order pharmacy directly.

* Please be advised that it may take up to two weeks for you to receive your first order, so make sure you have at least a 14-day supply before ordering or request a 30-day supply from your provider to fill at your local pharmacy.

Here are the quarterly changes to the Pharmacy Benefit Dimensions drug formulary.

The following medications will be added to the formulary:

The following new generic medications are available:

The following medications were reviewed and will remain non-formulary:

• BAXFENDY^™ tablets
• ORZEYFUL^® tablets
• SIMTRIYO^® ER capsules
• TRIMBOW^® inhalation aerosol
• HEPCLUDEX^® subcutaneous injection
• TRUTAKNA™ subcutaneous injection
• IMMGOLIS^® subcutaneous injection
• GARZULYS^® subcutaneous injection
• CAVHANZA^® orally disintegrating tablets
• TIOCYSTIN tablets
• GWYN LO^® transdermal system
• QLONILIK oral solution

Please reach out with any questions you may have. To best assist you, choose from the following:

Questions about your pharmacy benefits as a PBD member? Contact Member Services, 1-888-878-9172.

Questions about a claim from a pharmacy or provider? Contact our Pharmacy Help Desk, (716) 635-3578.

Questions about the benefits of partnering with PBD? Contact our Sales Department, (716) 860-0743.

Stay informed: pbdrx.com | LinkedIn | PBD News