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Lowest Net Cost Formulary Update Bulletin - Mid Year Updates

July 10, 2026

The changes in this update apply only to groups that use the OptumRx Lowest Net Cost (LNC) formulary. These updates do not apply to groups using any other formulary. The majority of these updates include decisions that occurred as a result of the May 2026 Pharmacy and Therapeutics Committee (P&T) meeting. Members impacted by these changes will be sent a notification letter. 

FORMULARY UPDATES

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

Product

 Drug Class/Category

UM Programs

Formulary Status

Blenrep CancerPANon-Preferred Specialty
CardamystTachycardiaPA/QLNon-Preferred
HyrnuoCancerPA/QLNon-Preferred Specialty
KomziftiCancerPA/QLNon-Preferred Specialty
LymphirCancerPANon-Preferred Specialty
MyqorzoCardiomyopathyPA/QLNon-Preferred Specialty
RedemploChylomicronemiaPA/QLNon-Preferred Specialty
VoyxactNephropathyPA/QLNon-Preferred Specialty

Non-formulary Drugs/Exclusions

These drugs will move to non-formulary status and will no longer be covered, effective Oct. 1, 2026:

  • Premarin Tab
  • Promacta Tab
  • Thalitone Tab 15mg

These following drugs were removed from the formulary effective June 15, 2026.  There was no member impact at that time.

  • Byetta/exenatide 5mcg and 10mcg pen
  • Complera
  • Dificid tablet
  • Glycerol phenylbutyrate
  • Iressa
  • Kenalog-10 inj
  • Lyrica soln
  • Ondansetron 16mg tab
  • Purixan susp
  • Ravicti
  • Tepadina vials

 UTILIZATION MANAGEMENT UPDATES

Quantity Limits

These drugs will have new quantity limits June 15, 2026:

Drug Name

Quantity Limit

Tiglutik and Teglutik susp 2 tablets/day

Effective July 1, 2026

Drug Name

Quantity Limit

Durolane, Gel-One, Hymovis One, Monovisc, Synvisc-One 2 syringes per 180 days
Euflexxa, Synojoynt, Triluron, Gelsyn-3, GenVisc 850, Supartz FX, TriVisc, Visco-3, Synvisc6 syringes per 180 days
Hyalgan10 vials or syringes per 180 days
Hymovis4 syringes per 180 days
Orthovisc8 syringes per 180 days
Ivermectin6 mg tab    9 tablets per 180 days
Stromectol and ivermectin3 mg tab    modified to 18 tablets per 180 days

Effective August 1, 2026

Drug Name

Quantity Limit

Lynkuet2 capsules per day
Omlonti1 bottle per 25 days
Aqvesme2 tablets per day
Aqvesme1 syringe per 180 days