Lowest Net Cost Formulary Update Bulletin
The changes in this update apply only to groups that use the OptumRx Lowest Net Cost (LNC) formulary. These updates do not apply to groups using any other formulary. The majority of these updates include decisions that occurred as a result of the August 2026 Pharmacy and Therapeutics Committee (P&T) meeting. Members impacted by these changes will be sent a notification letter.
FORMULARY UPDATES
Additions
These drugs will be added to the formulary effective Oct. 1, 2026:
Product |
Drug Class/Category |
UM Programs |
Formulary Status |
| Lifyorli | Cancer | PA/QL | Specialty |
| Lunsumio Velo | Cancer | PA | Specialty |
The following drugs will be added to the formulary effective Jan. 1, 2027:
Product |
Drug Class/Category |
UM Programs |
Formulary Status |
| Tolvaptan tab/pak | Polycystic Kidney Disease | PA/QL | Specialty |
Non-formulary Drugs/Exclusions
Effective Sept. 8, 2026, Motegrity moved to non-formulary status.
These drugs were excluded from the pharmacy coverage effective Sept. 8, 2026:
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#eligible for medical benefit review
These drugs will move to non-formulary status and will no longer be covered, effective Jan. 1, 2027 (*generic available):
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UTILIZATION MANAGEMENT UPDATES
Prior Authorizations
Effective Oct. 1, 2026, Hemangeol sol requires prior authorization.
Effective Jan. 1, 2027, the following products will require prior authorization:
• Tolvaptan tab (generic for Jynarque)
• Tolvaptan tab (hyponatremia- generic for Samsca)
Quantity Limits
Effective Sept. 8, 2026, the following products have new quantity limits:
Product |
New Quantity Limit |
| Lerochol | 1 injection per 28 days |
| Yuviwel | 4 vials per 28 days |
| Zycubo | 1 vial per day |
Effective Oct. 1, 2026, the following products have new quantity limits:
Product |
New Quantity Limit |
| Lifyorli (125mg dose) | 18 capsules per 28 days |
| Lifyorli (150mg dose) | 27 capsules per 28 days |
Effective Jan. 1, 2027, the following products will have new quantity limits:
Product |
Quantity Limit |
| All glucose test strips | 100 strips per 30 days without insulin use or 200 strips per 30 days with insulin use |
| Cabenuva Susp | 1 kit per 28 days |
| Piqray 200 Mg Therapy Pack | 1 tablet per day |
| Piqray Therapy Pack | 2 tablets per day |
| Twiist | 1 kit per 30 days |
| Tolvaptan (hyponatremia) 30 mg tab | 60 tablets per 180 days |
| Tolvaptan (hyponatremia) 15mg tab | 30 tablets per 180 days |
| Tolvaptan (Jynarque) 15mg tab | 2 tablets per day |
| Tolvaptan (Jynarque) 30mg tab | 1 tablet per day |
