Pharmacy Formulary Update: Effective January 1, 2024

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.

FORMULARY UPDATES

Additions
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
•  Airsupra
•  Flovent Diskus/HFA
•  Joenja
•  Lumryz
•  Trokendi XR
•  Zavzpret

Moving to Excluded Status

Qalsody

Drug Management Program Updates

Adding Prior Authorization

Saxenda

Adding Quantity Limits

Wegovy (4 pens per 28 days)