Provider Alert! COVID-19 Medicaid Pharmacy Benefit Updated May 4, 2020

Attention: All Providers and Pharmacies
Effective Date: May 4, 2020

The Texas Vendor Drug Program (VDP) has implemented several changes in response to COVID-19. This notice contains the latest updates, as well as links to the previously implemented changes.

No-auto prior authorization (NAP) designation temporarily lifted: Normally, medications listed as NAP on the drug formulary by VDP require a manual hard stop in the system. Providers must call/fax to complete a prior authorization (PA) rather than allowing automated authorizations by reviewing historical pharmacy and medical claims.

In response to COVID-19, VDP changed NAP designations to NDP to reduce administrative burden. This may allow MCOs to determine if non-preferred criteria is met automatically with review of pharmacy and medical claims data. Please note that all NPA designations cannot be automated right away, and some will still require manual fax or call-in from the prescriber.

Azithromycin shortage: There have been reported shortages of azithromycin. VDP is unable to add other NDCs or antibiotic medications to the formulary. In the event pharmacies are unable to dispense the drug, providers, pharmacies, and MCOs should coordinate care to identify alternatives listed on the Medicaid formulary based on patient factors and diagnosis.

Below are the actions VDP has taken previously in response to VDP.

Temporary expansion of NDCs

• Voltaren (diclofenac sodium 1% gel) – effective April 10
• Tacrolimus – effective April 17
• Methylphenidate ER – effective April 23

Temporary expansion of drug list within classes

• Inhaled glucocorticoids – effective April 1
• Hypoglycemic insulin – effective April 1
• Bronchodilators, short-acting beta agonists – effective March 21

How this impacts providers: Pharmacies may not have access to certain medications due to shortages, and patients may need alternative therapies.

Next steps for providers: Providers, pharmacies, and MCOs should coordinate care to identify alternatives listed on the formulary based on patient factors and diagnosis. In the event no other antibiotic on the formulary is appropriate, and a non-formulary drug is medically necessary, providers and pharmacies should notify the MCO, who will submit a request to VDP for an override. 

If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.

For access to all provider alerts, log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers