23-1178sum Summary Update: Medication Trend Updates and Formulary - 4th Quarter 2023
Date: 10/16/23
Review formulary changes and medication safety issues
Stay up to date with information about:
- FDA approved the second over-the-counter naloxone nasal spray.
- Preferred biosimilar medications.
- Changes to the Health Net commercial Formulary, Medi-Cal Preferred Drug List (PDL) and Medicare Part D Formulary for the fourth quarter of 2023.
To obtain a comprehensive description of the above topics, the complete update, 23-1178 (PDF), is available on the Health Net provider portal, in the Provider Library under Updates and Letters > Updates and Letters for 2023 and Beyond; search for provider update 23-1178.
FDA approved the second over-the-counter (OTC) naloxone nasal spray, RiVive™
On July 28, 2023, the U.S. Food and Drug Administration (FDA) approved RiVive, 3 milligram (mg) naloxone hydrochloride nasal spray for OTC use. Naloxone is a nonprescription drug and is used for the emergency treatment of known or suspected opioid overdose. The first OTC naloxone product was Narcan® nasal spray which was approved back in March 2023.
Naloxone is a potential lifesaving medication designed to help reverse the effects of an opioid overdose in minutes. Drug overdose persists as a major public health issue in the United States, primarily driven by synthetic opioids. With the approval of RiVive as the second OTC naloxone nasal spray product, this will help increase consumer access to naloxone and reduce opioid overdose deaths throughout the country.
The approval of RiVive nasal spray for nonprescription use was supported by data from a study submitted by the manufacturer that showed similar levels of RiVive reach the bloodstream as an approved prescription naloxone product. The drug has been demonstrated to be safe and effective for use as directed on its label.
The nasal spray will come in a package of two 3-milligram doses in case the person overdosing does not respond to the first dose. RiVive will be available in early 2024 primarily to the United States harm reduction organizations and state governments for costs lower than other opioid antagonist nasal sprays.
Health Net prefers biosimilar medications
Biosimilars are FDA approved safe and effective medicines that are similar to existing biologic medicines. The FDA regulates biosimilar manufacturing to ensure that they scientifically demonstrate safety and effectiveness while showing no clinically meaningful differences. Biosimilars cost less than their brand name counterparts which indicate they can help lower the overall cost of care for members while still providing quality care. Refer to the complete update,
23-1178, for a listing of Health Net preferred biosimilar medications.
Changes to the Commercial Formulary, Medi-Cal PDL and Medicare Part D Formulary/Drug benefit changes
The Health Net Pharmacy and Therapeutics (P&T) Committee includes practicing physicians, pharmacists and other health care professionals. Each quarter, the P&T Committee reviews medications on the Formulary for commercial members, the PDL for Medi-Cal members, and the Medicare Part D Formulary for Medicare members to determine which medications remain on the same tier and which are moved. Refer to the complete update, 23-1178 (PDF), for a listing of some recent changes.
Pharmacy help line
For more information regarding changes to the Health Net Commercial Formulary, Medi-Cal drug benefits, or Medicare Part D Formulary, contact the proper pharmacy phone numbers listed below.
Product | Phone number | Fax number |
|---|---|---|
Pharmacy Benefit (Medi-Cal Rx) | 800-869-4325 | |
Medical Benefit Drugs (Medi-Cal) | 833-953-3436 | |
Commercial Pharmacy Services | 800-548-5524, option #3 | 866-399-0929 |
Medicare Pharmacy Service Center | 800-977-8226 |
Additional information
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by phone or through the Health Net provider portal.
This information applies to Physicians and Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.