News

The changes in this bulletin apply to all groups that use OptumRx Lowest Net Cost (LNC) Formulary. These changes include decisions that occurred as a result of our September 2023 Pharmacy and Therapeutics Committee (P&T) meeting. Members negatively impacted by one of these changes will be sent a letter in November.

Seasonal Preventive Flu Vaccines Members with BSA pharmacy benefit coverage with OptumRx can get flu vaccines covered under their pharmacy benefit at any in-network pharmacy. Flu vaccines administered by network pharmacies are subject to an administration fee that will be the group’s responsibility. Members are responsible for the full cost of the vaccine administered in out-of-network pharmacies.

To support appropriate utilization management, we continually review relevant clinical guidelines and reassess our requirements. Utilization management criteria for Freestyle and Dexcom CGMs will be updated for some of our formularies effective September 11, 2023.

Members with Blue Solutions pharmacy benefit coverage with OptumRx that use the Lowest Net Cost (LNC) Formulary will have pharmacy changes effective October 1, 2023.

Members with Blue Solutions pharmacy benefit coverage with OptumRx, we will be adding Hadlima and Adalimumab-adaz—biosimilar options for Humira

Scientists already know how genes interact with trillions of human cells to differentiate and form the essential building blocks of the human body and are now turning them into clinical treatments and cures. These genetic and cellular treatments are