Provider Alert! URGENT – Makena (hydroxyprogesterone caproate) formulary change
Attention: OB providers
Subject: URGENT – Makena (hydroxyprogesterone caproate) formulary change
Effective Date: January 30, 2020
Call to action: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, January 30, 2020. Brand Makena formulations (intramuscular solution for injection, and subcutaneous auto-injectors) will remain on the preferred drug list (PDL). VDP has moved all generic hydroxyprogesterone caproate formulations to non-preferred drug status. Compounded formulations are not covered under the Medicaid formulary. Medicaid managed care plans are required to follow the PDL for medications processed through pharmacy drug benefits.
How this impacts providers: Pharmacy claims for generic hydroxyprogesterone caproate will be denied. Per state guidelines, prior authorization requests will only be honored if the patient has attempted and failed a preferred brand Makena formulation.
Next steps for providers: Providers should follow the new formulary guidelines for impacted members. There is currently a drug shortage for Makena intramuscular solution for injection. Providers should coordinate with dispensing pharmacies to ensure members receiving generic hydroxyprogesterone are switched to Makena subcutaneous auto-injectors.
The Texas Managed Medicaid STAR/CHIP/STAR Kids formulary are available here:
https://txstarchip.navitus.com/pages/formulary.aspx
If you have questions, please contact us at:
tchppharmacy@texaschildrens.org.
For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers
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