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Lowest Net Cost Formulary Update Bulletin - Effective October 1, 2025
August 8, 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 May 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 Oct. 1, 2025.
| Product | Drug Class/Category | Utilization Management Programs | Formulary Status |
| Alhemo | Hemophilia | --- | Non-Preferred Specialty |
| Alyftrek | Cystic Fibrosis | PA/QL | Non-Preferred Specialty |
| Bizengri | Cancer | PA | Non-Preferred Specialty |
| Datroway | Cancer | PA | Non-Preferred Specialty |
| Hympavzi | Hemophilia | --- | Non-Preferred Specialty |
| Itovebi | Cancer | PA/QL | Non-Preferred Specialty |
| Revuforj | Cancer | PA/QL | Non-Preferred Specialty |
| Tryngolza | Familial Chylomicronemia Syndrome (FCS) | PA/QL | Non-Preferred Specialty |
| Vyloy | Cancer | PA | Non-Preferred Specialty |
| Ziihera | Cancer | PA | Non-Preferred Specialty |
Moving to Nonformulary Status
These drugs will move to nonformulary status effective Oct. 1, 2025.
• Allopurinol tab 200mg
• Arava 10mg
• Estrace tab 1mg
• Estrace tab 2mg
• Loestrin FE tab 1.5/30
• Mesnex tab 400mg
• Solu-Cortef inj 100mg
Medical Benefit Only
The following specialty drugs will be eligible for coverage under the medical benefit effective Oct. 1, 2025.
• Aucatzyl
• Kebilidi
• Ryoncil