Pharmacy Updates Effective October 1, 2023

Members with PAI pharmacy benefit coverage with OptumRx that use the Lowest Net Cost (LNC) Formulary will have pharmacy changes effective October 1, 2023.  These changes include decisions that occurred as a result of our May and July 2023 Pharmacy and Therapeutics Committee (P&T) meetings. Members negatively impacted by one of these changes will be sent a letter in August.

FORMULARY UPDATES
Additions
These drugs will be added to the formulary effective Oct. 1, 2023. Bold indicates a specialty drug.
 
Product    Formulary Status
Adalimumab-adaz*#    Preferrred
Altuviiio*    Non-Preferred
Briumvi*    Non-Preferred
Daybue*#    Non-Preferred
Hadlima*#    Preferred
Jaypirca*#    Non-Preferred
Krazati*    Non-Preferred
Orserdu*#    Non-Preferred
Rezlidhia*    Non-Preferred
Skyclarys*#    Non-Preferred
Sunlenca*#    Non-Preferred
Syfovre*    Non-Preferred
 
* Requires Prior Authorization | # Quantity Limit | ^ Step Therapy    
 
Medical Benefit Only
These specialty drugs will only be eligible for coverage under the medical benefit: Lamzede, Lunsumio, Rebyota, Sezaby.

Exclusions
The following drugs will move to non-formulary status, effective Oct. 1, 2023. 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)
•    Gilenya Cap 0.5mg
 
•    Olopatadine Spr 0.6%
 
•    Poly-Vi-Flor Sus 0.25/Ml
 
•    Poly-Vi-Flor Sus/Iron
 
Note: The recently-launched drug Leqembi, used to treat Alzheimer’s disease, will remain excluded based on the recommendation of the P&T committee. The drug’s status will be reviewed again later in 2023 once additional data on its effectiveness and safety is available.