News
Lowest Net Cost Formulary Update Bulletin
February 4, 2025
The changes in this update apply to all groups that use OptumRx
The majority of these changes include decisions that occurred as a result of our November 2024 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in February.
Formulary Update Additions
These drugs will be added to the formulary effective April 1, 2025.
| Product | Drug Class/Category | Utilization Management Programs | Formulary Status |
| Anktiva | Cancer | Prior Authorization | Non-Preferred Specialty |
| Iqirvo | Cholangitis | Prior Authorization/Quantity Limit | Non-Preferred Specialty |
| Ojemda | Cancer | Prior Authorization | Non-Preferred Specialty |
| Rytelo | Cancer | Prior Authorization | Non-Preferred Specialty |
| Tevimbra | Cancer | Prior Authorization | Non-Preferred Specialty |
| Xolremdi | WHIM Syndrome | Prior Authorization/Quantity Limit | Non-Preferred Specialty |
Moving to Nonformulary Status
The following drugs will move to nonformulary status effective April 1, 2025. The products listed have alternatives available on the formulary, many times at a lower cost to the member. Note: some covered alternatives may require prior authorization (PA).
- Clindamycin-Tretinoin Gel
- Naftifine Gel 2%
- Naftin Gel 2%
- Tazarotene Gel 0.05%
- Tazarotene Gel 0.1%
- Tazorac Gel 0.05%
- Tazorac Gel 0.1%
Medical Benefit Only
Beginning April 1, 2025, the specialty drug BEQVEZ will only be eligible for coverage under the medical benefit.
DRUG MANAGEMENT PROGRAM UPDATES
Prior Authorization
Beginning April 1, 2025, the drug SUCRAID will require prior authorization.
Step Therapy
Beginning April 1, 2025, the drug SYNTHROID will require step therapy (generic first) for all new utilizers.