Provider Alert! Medicaid drug formulary changes
Attention: All Providers
Effective Date: July 31, 2020
Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.
Call to action: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, July 30, 2020. Select medications will be moving from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wanted to notify you in advance so that these changes do not impact the ability of your STAR and STAR Kids members to obtain their medications. A summary of the changes is included below.
How this impacts providers: Preferred and non-preferred medications may continue to require clinical prior authorizations. In addition to any clinical prior authorization requirements, non-preferred medications will also require a “step therapy prior authorization.” This means that STAR and STAR Kids members must have attempted and failed at least one preferred medication before obtaining a non-preferred medication. The preferred drug list (PDL) can be found on the VDP website: https://www.txvendordrug.com/formulary/prior-authorization/preferred-drugs. Medicaid managed care plans are required to follow the PDL.
Next steps for providers: Preferred drugs are medications recommended by the Texas Drug Utilization Review Board for their efficaciousness, clinical significance, cost effectiveness, and safety. Texas Children’s Health Plan encourages providers to initiate a preferred medication to members new to therapy. When possible, Texas Children’s Health Plan also encourages switching existing members to a preferred agent.
Generics or alternatives with similar strengths/formulations available as preferred
| PDL Drug Class | Medication | Current Status | Status effective July 30, 2020 | Medications on Preferred Drug List |
| Stimulants | Adderall XR 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg (oral) | Preferred | Non-preferred* | Dextroamphetamine / Amphethamine ER 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg |
| Stimulants | Jornay PM | No status | Non-preferred* | Methylphenidate CD, ER, LA |
| Anticonvulsants | Lyrica capsule, solution (oral) | Preferred | Non-preferred* | Pregabalin capsule, solution |
| Antidepressants, SSRI | Fluoxetine 60 mg (oral) | Preferred | Non-preferred* | Fluoxetine 20 mg, 40 mg tablets |
| Antivirals, Oral/Nasal | Tamiflu capsule (oral) | Preferred | Non-preferred* | Oseltamivir capsule |
| PAH Agents, Oral and Inhaled | Letairis (oral) | Preferred | Non-preferred* | Ambrisentan |
| Antiparkinson’s Agents | Bromocriptine (oral) | Preferred | Non-preferred | Amantadine, Benztropine, Carbidopa/Levodopa, Pramipexole, Ropinirole, Trihexyphenidyl |
| Prenatal Vitamins | Citranatal DHA (oral) | Preferred | Non-preferred | Citranatal 90 DHA, Citranatal Assure,
Citranatal B-Calm, Citranatal Harmony, Citranatal Rx Trinatal Rx 1 |
| Prenatal Vitamins | Vol-Plus (oral) | Preferred | Non-preferred | Vitafol-OB
Vitafol Ultra |
| Amino Acids | Endari powder | No status | Non-preferred | |
| Antidiabetic Agents | Rybelsus | No status | Non-preferred | Ozempic |
| Antihypoglycemia Agents | Gvoke Hypopen, Gvoke PFS | No status | Non-preferred | Glucagen, Glucagon |
| Antimigraine Agents | Ubrelvy | No status | Non-preferred | Aimovig, Ajovy, Emgality |
| Sickle Cell | Siklos, Oxbryta | No status | Non-preferred | Droxia, Hydrea, hydroxyurea |
| Stimulants | Dextroamphetamine / Amphethamine ER (oral) | Non-preferred | Preferred | |
| Antidepressants, Other | Venlafaxine (oral) | Non-preferred | Preferred | |
| Antivirals, Oral/Nasal | Valcyte (solution) | Non-preferred | Preferred | |
| Lipotropics, Other | Fenofibrate capsule (Lofibra) (oral) | Non-preferred | Preferred | |
| Lipotropics, Statins | Rosuvastatin (oral) | Non-preferred | Preferred | |
| PAH Agents, Oral and Inhaled | Ambrisentan (oral),
Revatio suspension (oral) |
Non-preferred | Preferred | |
| Sedative Hypnotics | Eszopiclone (oral), Zaleplon (oral) | Non-Preferred | Preferred | |
| Tardive Dyskinesia | Ingrezza (oral) | Non-Preferred | Preferred |
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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