News

Beginning Jan. 1, 2025, Humira (brand) will be removed from the Lowest Net Cost formulary. Adalimumab biosimilars will instead be the preferred products for this formulary.

The vaccines and immunizations in this update apply to all groups that use OptumRx, as summarized in the ‘Seasonal Vaccine Coverage’ and ‘Non-seasonal Coverage’ sections, align with the recommended vaccines included on the ACA HCR list of preventive medications. This list undergoes periodic review and may change based on guideline updates.

These changes apply to all groups that have OptumRx as their PBM and use the Lowest Net Cost (LNC) Formulary. They do NOT apply to groups using any other formulary.

According to a new report from PricewaterhouseCoopers' (PwC) Health Research Institute, healthcare costs are expected to grow by 8% next year — which is the largest projected increase since 2012.1

The changes in this bulletin apply to all groups that use OptumRx Similar to the changes recently made to Zepbound, it has been brought to our attention that members on plans that do NOT include weight loss medications were unable to fully utilize

We have recently updated our Humira/biosimilar coverage for members with PAI’s pharmacy benefit coverage with OptumRx that use the Lowest Net Cost (LNC) Formulary.

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 February 2024 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in May.

April 15, 2024, is the official deadline to submit data to PAI in order for it to be included within our RxDC reporting.

PAI is expanding its partnership with Smart Data Solutions (SDS) for AI- and automation-driven clearinghouse services, marking a significant milestone in our collaboration. The new end-to-end clearinghouse and EDI gateway solution, with the AI- and

In 2023, PAI welcomed a large dental carrier to our book of business. With a quick implementation timeline and stringent carrier requirements, PAI was able to adeptly move all hands on deck to provide streamlined service to the carrier’s 25,000