Lowest Net Cost Formulary Update Bulletin - Effective January 1, 2026

The Changes in This Update Apply to all Groups That use OptumRx

The majority of these updates include decisions that occurred as a result of the August 2025 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by these changes will be sent a notification letter in November. 

FORMULARY UPDATES

Additions
These drugs will be added to the formulary effective Jan. 1, 2026:

Diabetes Preferred Test Strip Update

Effective Sept. 15, 2025, Contour and Accu-Chek were added as preferred diabetic test strips joining OneTouch, which was already preferred. As a result, all three brands, OneTouch, Contour and Accu-Chek, will remain preferred on the formulary until Dec. 31, 2025. 

Upcoming Change: 
Effective Jan. 1, 2026, as part of the broader formulary updates, OneTouch test strips will move to non-preferred status on the formulary and will require prior authorization. Contour and Accu-Chek test strips will be the preferred options on the formulary. Member disruption communications will be included with the overall Jan. 1, 2026 formulary change notifications.

Utilization Management Programs 

Quantity Limits
Effective Nov. 1, 2025, the following products will have new quantity limits:
 

Moving from Specialty to Non-specialty 

Effective Nov. 1, 2025, the following products will move from specialty to non-specialty status:

• Entecavir tablets
• Baraclude tablets
• Baraclude solution

Medical Benefit Only

The following specialty drugs became eligible for coverage under the medical benefit effective Oct. 1, 2025:
 

Additional Update: 
Apretude - Prior authorization requirements have been removed.