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Published Date: 2025-06-24

Recent Addition to Pennsylvania’s Naloxone Standing Order

As you know, naloxone is a lifesaving medication that can be used to reverse the effects of an opioid overdose. Since 2023, naloxone has been available as an over-the-counter product. Pennsylvania has had a standing order for naloxone in place since 2015.

What is a Standing Order?

A standing order is a prescription written for the general public issued by Pennsylvania’s Acting Secretary of Health. It can be used for both prescription and over-the-counter (OTC) naloxone products. It can be used by:

Pharmacies to bill naloxone to insurance companies
Community-based organizations to purchase naloxone to provide to people at risk of overdose, and their family and friends.
First responders to leave behind after providing EMS services.

What is new?

The PA Secretary of Health, Dr. Debra Bogen, has authorized an addition and update to Pennsylvania’s Naloxone Standing Order to include 3mg naloxone nasal spray (RiVive) and create a tiered standing order. Similar to the order used in Massachusetts, this new, tiered standing order is flexible regarding covered formulations, but guides stakeholders toward options that offer the greatest benefit based on existing evidence.

Tiered Standing Order

Preferred Formulations

Naloxone Nasal Spray 4mg/0.1ml

Naloxone Nasal Spray 3mg/0.1ml

Naloxone Nasal Spray 2mg/2ml

Naloxone 0.4mg/ml in a 1ml single dose vial—intramuscular injection

Alternative Formulations; second line options

Naloxone Nasal Spray 8mg/0.1ml

Naloxone 5mg/0.5ml in a single dose prefilled syringe- intramuscular or subcutaneous injection

New OTC product: RiVive. Although Highmark Wholecare currently does not cover RiVive, we offer coverage for alternative products. See below for options covered by Highmark Wholecare.

Highmark Wholecare Coverage

The following products are preferred for the specific lines of business:

Medicaid:

Kloxxado Nasal Spray, LifEMS Naloxone Kit, Naloxone Cartridge/Syringe/Vial/Nasal spray, Narcan Nasal Spray, Zimhi Syringe, Rextovy

Medicare DSNP:

Kloxxado, naloxone HCL Injection (0.4mg/mL, 4mg/10mL), naloxone HCL Injection solution cartridge, naloxone HCL injection solution prefilled syringe, naloxone nasal spray (prescription version only), Opvee nasal spray, Zimhi prefilled syringe

For more information and to see the standing order, please visit the Commonwealth of Pennsylvania’s website.