Pharmacy Formulary Update: Effective January 1, 2024
October 26, 2023
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 September 2023 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in November.
These drugs will be added to the formulary effective Jan. 1, 2024.
Medical Benefit Only
These specialty drugs will only be eligible for coverage under the medical benefit: Adstiladrin, Rezzayo, Zynyz.
Moving to Nonformulary Status
The following drugs will move to nonformulary status, effective Jan. 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).
• Advair Diskus
• Flovent Diskus/HFA
• Trokendi XR
Moving to Excluded Status
Drug Management Program Updates
Adding Prior Authorization
Adding Quantity Limits
Wegovy (4 pens per 28 days)