21-726 Medication Trend Updates and Formulary Changes - 4th Quarter 2021
Date: 10/25/21
This information applies to Physicians and Participating Physician Groups (PPGs).
This information applies to Medi-Cal in Fresno, Kings and Madera counties.
Review changes that improve patient safety and encourage medication adherence
Stay up to date with information about:
- New buprenorphine practice guidelines.
- Changes to the CalViva Health Medi-Cal Preferred Drug List (formulary) for the fourth quarter of 2021.
New buprenorphine practice guidelines, expanding access to treatment for opioid use disorder
According to the Centers for Disease Control and Prevention, as of June 2020, 13% of Americans reported starting or increasing substance use as a way of coping with stress or emotions related to COVID-19. The reported number of deaths of opioid specific overdose in California in 2020 was 5,659 (a 70% increase compared to 2019). Those with substance use disorders (SUD) are both more likely to develop COVID-19 and experience worse COVID-19 outcomes, including higher risk of hospitalization and mortality.1
The U.S. Department of Health and Human Services (HHS) published the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder: "exempting physicians from certain certification requirements needed to prescribe buprenorphine for opioid use disorder (OUD) treatment."2 Physicians utilizing this exemption will be limited to treating no more than 30 patients with buprenorphine for opioid use disorder at any one time.
Call to Action for Health Net Providers:
- Prioritize COVID-19 vaccinations among patients with a history of SUD.
- Educate on effective Medication Assisted Treatment (MAT), especially buprenorphine treatment, per the Substance Abuse and Mental Health Services Administration (SAMHSA) guidelines.
- Identify patients who begin showing signs of substance use disorder.
- Create opioid tapering plans for those on high doses of combined opioids.
- Co-prescribe naloxone to patients to reduce risk of overdose/death.
1 (Wang, Q., et al., Molecular Psychiatry, 2020)
2 Department of health and Human Services
Preferred Drug List changes
The Pharmacy and Therapeutics (P&T) Committee, which includes practicing physicians, pharmacists and other health care professionals, reviews medications on the CalViva Health Medi-Cal Preferred Drug List each quarter to determine medications to stay on or be moved to a different status. A list of some recent changes is provided in the table below. The list contains brand-name prescription medications, status, other medication choices, and comments for the fourth quarter of 2021.
A complete CalViva Health Medi-Cal Preferred Drug List is available on the provider website under Pharmacy Information.
Medication | Status | Formulary alternative(s) | Comments |
|---|---|---|---|
Abecma® (idecabtagene vicleucel) for IV infusion | Medical benefit3 |
| The first chimeric antigen receptor (CAR) T cell therapy for relapsed/refractory multiple myleloma after four or more prior lines of therapy, including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody. |
Aduhelm™ (aducanumab) for IV infusion | Medical benefit3 |
| Aduhelm is an amyloid beta-directed antibody indicated for the treatment of Alzheimer’s disease. Treatment with Aduhelm should be initiated in patients with mild cognitive impairment or mild dementia stage of disease, the population in which treatment was initiated in clinical trials. There are no safety or effectiveness data on initiating treatment at earlier or later stages of the disease than were studied |
Nulibry™ (fosdenopterin) for IV infusion | Medical benefit3 |
| A cyclic pyranopterin monophosphate (cPMP) substrate replacement therapy and the first treatment for Molybdenum Cofactor Deficiency (MoCD), type A only. |
3 Prior authorization (PA) is required to verify member eligibility and that the member satisfies clinical protocols to ensure appropriate use of the medication.
Additional information
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.