News
Lowest Net Cost Formulary Update Bulletin
May 13, 2025
The changes in this update apply to all groups that use OptumRx
The majority of these changes include decisions that occurred as a result of our February 2025 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter this month.
FORMULARY UPDATES
Additions
These drugs will be added to the formulary effective July 1, 2025.
| Product | Drug Class/Category | Utilization Management Programs | Formulary Status |
| Lazcluze | Cancer | PA/QL | Non-Preferred Specialty |
| Livdelzi | Primary Biliary Cholangitis | PA/QL | Non-Preferred Specialty |
| Miplyffa | Niemann-Pick | PA/QL | Non-Preferred Specialty |
| Nemluvio | Prurigo Nodularis/ Atopic Dermatitis | PA/QL | Preferred Specialty |
| Teriparatide | Osteoporosis | PA | Generic Specialty |
| Vafseo | CKD-related anemia | PA/QL | Non-Preferred Specialty |
| Voranigo | Cancer | PA/QL | Non-Preferred Specialty |
Stelara Biosimilars Coverage Update
Beginning July 1, 2025, Stelara (brand) will be removed from the Lowest Net Cost formulary. The biosimilars Yesintek and Selarsdi will instead be the preferred products.
Members using brand Stelara will be notified and supported through their transition to a preferred product. Additionally, providers will be notified of these formulary changes prior to implementation to ensure a seamless transition.
This biosimilar strategy provides continued quality of care for patients, guaranteed supply, availability of all strengths, and affordability for patients, including manufacturer copay assistance programs and significant cost reduction for plan sponsors.
Medical Benefit Only
Beginning July 1, 2025, the specialty drugs NIKTIMVO and TECELRA will be eligible for coverage under the medical benefit only. Note: generics of these medications will be on formulary.
Moving to Nonformulary Status
FORTEO and VICTOZA will move to nonformulary status effective July 1, 2025.