News
Lowest Net Cost Formulary Update Effective Jan. 1, 2025
November 11, 2024
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 August 2024 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in November.
Formulary Update Additions
These drugs will be added to the formulary effective Jan. 1, 2025.
| Product | Drug Class/Category | Utilization Management Programs | Formulary Status |
|---|---|---|---|
| Alyglo | Misc. Therapeutic Agents | PA | Specialty |
| Cequa | Ophthalmic Agents | PA | Non-Preferred Brand |
| Eohilia | Inflammatory Bowel Disease Agents | PA/QL | Non-Preferred Brand |
| Miebo | Misc. Therapeutic Agents | PA | Preferred Brand |
| Rezdiffra | Misc. Therapeutic Agents | PA | Specialty |
| Tyrvaya | Misc. Therapeutic Agents | PA | Non-Preferred Brand |
| Voydeya | Misc. Therapeutic Agents | PA/QL | Specialty |
| Winrevair | Misc. Therapeutic Agents | PA/QL | Specialty |
Moving to Nonformulary Status
The following drugs will move to nonformulary status effective Jan. 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).
- Rivfloza injection
- Humira (see previous pharmacy bulletins for more information)
Specialty Status Update
The drug WAKIX will move to specialty status effective Jan. 1, 2025.
Drug Management Program Updates
Prior Authorization
Beginning Jan. 1, 2025, the drug XIIDRA will require prior authorization.
Quantity Management
Beginning Dec. 1, 2024, SUNOSI TAB 75MG will have a new quantity limit of 2 tabs per day.