News
Back to News
Lowest Net Cost Formulary Update Bulletin
May 2, 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 February 2024 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in May.
FORMULARY UPDATES: ADDITIONS
These drugs will be added to the formulary effective July 1, 2024.
Product | Management Programs | Formulary Status |
| Akeega | PA | NON-PREFERRED BRAND SPECIALTY |
| Aphexda | PA | NON-PREFERRED BRAND SPECIALTY |
| Daxxify | PA | NON-PREFERRED BRAND SPECIALTY |
| Elrexfio | PA | NON-PREFERRED BRAND SPECIALTY |
| Ojjaara | PA | NON-PREFERRED BRAND SPECIALTY |
| Sohonos | PA | NON-PREFERRED BRAND SPECIALTY |
| Talvey | PA | NON-PREFERRED BRAND SPECIALTY |
| Xdemvy | PA/QL | NON-PREFERRED BRAND SPECIALTY |
| Zurzuvae | PA/QL | NON-PREFERRED BRAND |
Optional Inclusion List Addition
Beginning July 1, 2024, the following drug will be covered for groups that have selected optional Weight Loss drug coverage: Zepbound (tirzepatide)
Non-Essential/Non-FDA Approved Exclusions
Beginning July 1, 2024, the following products will no longer be covered:
- Nebusal
- Nutritional Supplements (Glytactin)
- Oracit
Updates to HCR/ACA Preventive Drug List
Beginning July 1, 2024, the following updates will go into effect for the ACA Covered Drugs at $0 Cost Share List:
- Aspirin Max age limit: 55 years
- Bowel Prep agents: New age edit of 45-75 years of age