Lowest Net Cost Formulary Update Bulletin - Mid Year Updates
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 May 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 Aug. 1, 2026:
Product |
Drug Class/Category |
UM Programs |
Formulary Status |
| Blenrep | Cancer | PA | Non-Preferred Specialty |
| Cardamyst | Tachycardia | PA/QL | Non-Preferred |
| Hyrnuo | Cancer | PA/QL | Non-Preferred Specialty |
| Komzifti | Cancer | PA/QL | Non-Preferred Specialty |
| Lymphir | Cancer | PA | Non-Preferred Specialty |
| Myqorzo | Cardiomyopathy | PA/QL | Non-Preferred Specialty |
| Redemplo | Chylomicronemia | PA/QL | Non-Preferred Specialty |
| Voyxact | Nephropathy | PA/QL | Non-Preferred Specialty |
Non-formulary Drugs/Exclusions
These drugs will move to non-formulary status and will no longer be covered, effective Oct. 1, 2026:
-
Premarin Tab
-
Promacta Tab
-
Thalitone Tab 15mg
These following drugs were removed from the formulary effective June 15, 2026. There was no member impact at that time.
-
Byetta/exenatide 5mcg and 10mcg pen
-
Complera
-
Dificid tablet
-
Glycerol phenylbutyrate
-
Iressa
-
Kenalog-10 inj
-
Lyrica soln
-
Ondansetron 16mg tab
-
Purixan susp
-
Ravicti
-
Tepadina vials
UTILIZATION MANAGEMENT UPDATES
Quantity Limits
These drugs will have new quantity limits June 15, 2026:
Drug Name |
Quantity Limit |
| Tiglutik and Teglutik susp | 2 tablets/day |
Effective July 1, 2026
Drug Name |
Quantity Limit |
| Durolane, Gel-One, Hymovis One, Monovisc, Synvisc-One | 2 syringes per 180 days |
| Euflexxa, Synojoynt, Triluron, Gelsyn-3, GenVisc 850, Supartz FX, TriVisc, Visco-3, Synvisc | 6 syringes per 180 days |
| Hyalgan | 10 vials or syringes per 180 days |
| Hymovis | 4 syringes per 180 days |
| Orthovisc | 8 syringes per 180 days |
| Ivermectin | 6 mg tab 9 tablets per 180 days |
| Stromectol and ivermectin | 3 mg tab modified to 18 tablets per 180 days |
Effective August 1, 2026
Drug Name |
Quantity Limit |
| Lynkuet | 2 capsules per day |
| Omlonti | 1 bottle per 25 days |
| Aqvesme | 2 tablets per day |
| Aqvesme | 1 syringe per 180 days |
