MedicaidCoverageLow impact

22-407 Medication Trend Updates and Formulary Changes - 1st Quarter 2022

Q: Who is affected by this change?

This affects Health Net Family Medicine, Internal Medicine, Pediatrics, Gastroenterology, Pain Management providers in CA on Medicaid plans.

Health Net·CA · Family Medicine, Internal Medicine, Pediatrics +2 more·Prior Authorization

Effective date

Not stated

We identified it

Jun 20, 2026

Days to comply

—

Summary

CalViva Health issued a fresh policy update for Medi-Cal providers in three California counties regarding new FDA warnings about dental risks from buprenorphine and formulary changes affecting two rare pediatric medications that are now carved out from coverage.

Action Required

Action needed

Immediately: Providers prescribing buprenorphine must perform baseline dental evaluations and counsel patients about dental risks. For Bylvay and Livmarli prescriptions, contact CalViva Health at 888-893-1569 as these medications are now carved out from formulary coverage. Update clinical protocols to include dental screening for buprenorphine patients.

Related policy hubs

Health Net policies CA policy changes Family Medicine Internal Medicine Pediatrics Gastroenterology Pain Management