Provider Alert! VDP Formulary Updates – Update 3tcph
Attention: All Providers and Pharmacies
Effective Date: April 21, 2020
Call to action: VDP temporarily revised the preferred drug list to address reported possible drug shortages. A new claims processing edit has also been added to prevent overutilization of antimalarial drugs.
Expanded NDCs: The non-preferred status of certain generic formulation NDCs were temporarily removed. The change allows pharmacies to dispense these drugs without requiring a non-preferred prior authorization, and provide continued access to necessary medication. The full list of NDCs can be found on the VDP website:
Expanded drug list: The non-preferred status for drugs within certain drug classes were temporarily removed in response to real or potential drug shortages. The change allows providers to prescriber these drugs without requiring a non-preferred prior authorization, This is a temporary change until the preferred products are sufficiently available in the market. A list of added drugs can also be found on the VDP website.
- Inhaled glucocorticoids – effective April 1
- Hypoglycemic insulin – effective April 1
- Bronchodilators, short-acting beta agonists – effective March 21
New limits for antimalarial drugs: On March 20, 2020, the Texas State Board of Pharmacy (TSBP) adopted emergency rules regarding dispensing of antimalarial drugs to prevent stockpiling. The rule does not apply to a prescription issued for a person already established on the medication for treatment of conditions such as rheumatoid arthritis or lupus.
Texas Medicaid has also implemented a claims processing edit to align with TSBP to prevent inappropriate use of medications. Members who have not had at least one (1) claim for chloroquine, hydroxychloroquine, and mefloquine in the past year are not subject to any rules. On or after March 23, members new to therapy will be limited to a 14-day supply and no refills. This edit will be live as of April 20, 2020.
How this impacts providers: Providers are encouraged to review the list of alternative medications in the event their patient is unable to obtain medication from their pharmacy. Pharmacies should dispense alternative NDCs if others are unavailable. Providers should also clarify the intended of use antimalarial drugs for patients new to therapy on or after March 23, 2020.
Next steps for providers: Prescribers and pharmacies should continue to monitor their patients, and report drug availability issues to HHSC using Form 1315.
If you have any questions, please email Provider Network Management at: email@example.com.