Lowest Net Cost Formulary Update Bulletin - Effective July 1, 2026
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 February 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 July 1, 2026:
Product |
Drug Class/Category |
UM Programs |
Formulary Status |
| Brinsupri | Respiratory | PA/QL | Non-Preferred Specialty |
| Dawnzera | Hereditary Angioedema | PA/QL | Non-Preferred Specialty |
| Hernexeos | Antineoplastic | PA/QL | Non-Preferred Specialty |
| Inlexzo | Antineoplastic | PA | Non-Preferred Specialty |
| Inluriyo | Antineoplastic | PA/QL | Non-Preferred Specialty |
| Jascayd | Respiratory | PA/QL | Non-Preferred Specialty |
| Leqembi Iqlik | Alzheimer’s | PA/QL | Non-Preferred Specialty |
| Modeyso | Antineoplastic | PA | Non-Preferred Specialty |
Exclusions
These drugs will move to non-formulary status and be excluded from coverage effective July 1, 2026:
-
Armour Thyroid*
-
Brilinta Tab
-
Brimonidine Gel 0.33%
-
Entresto Tab
-
Korlym Tab 300mg
-
Niva Thyroid*
-
NP Thyroid*
-
Sod Sul/Sulf Liq 10-5%
-
Sprycel Tab
-
Tasigna Cap
-
Thyroid*
*Not eligible for formulary exception review.
UTILIZATION MANAGEMENT UPDATES
Quantity Limits
These drugs will have new quantity limits effective July 1, 2026:
Drug Name |
Quantity Limit |
| Fanapt Tab | 2 tablets/day |
| Fanapt Titration Pack A | 2 starter packs/365 days |
| Fanapt Titration Pack B | 2 starter packs/365 days |
| Fanapt Titration Pack C | 2 starter packs/365 days |
| Latuda Tab | 1 tablet/day |
| Latuda Tab 80 Mg | 2 tablets/day |
| Rexulti Tab | 1 tablet/day |
| Vraylar Cap | 1 capsule/day |
| Vraylar Therapy Pack | 2 starter packs/365 days |
