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Formulary Update Bulletin: Effective April 1, 2024

January 30, 2024

The changes in this bulletin apply to all groups that use OptumRx Lowest Net Cost (LNC) Formulary. 

These changes include decisions that occurred as a result of our November 2023 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in February.

Formulary Update Additions

These drugs will be added to the formulary effective April 1, 2024.


Management Programs

Formulary Status

BrixadiQuantity LimitNon-Preferred
VanflytaPrior AuthorizationNon-Preferred


Moving to Nonformulary Status

The following drugs will move to nonformulary status, effective April 1, 2024. The products listed in this section have alternatives available on the formulary, many times at a lower cost to the member. Note: some covered alternatives may require prior authorization (PA).

  • Aubagio
  • Daliresp
  • Feraheme
  • Latuda
  • Mirvaso
  • Prezista
  • Pylera
  • Selzentry
  • Suprep Bowel Prep Kit
  • Sutent