Provider Alert! Medicaid drug formulary changes
Date: January 26, 2021
Attention: All Providers
Effective Date: January 28, 2021
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, January 28, 2021. 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.
| PDL Drug Class | Medication | Current Status | Status effective Jan 28, 2021 | Medications on Preferred Drug List |
| Antibiotics, Vaginal | Metronidazole (vaginal) | Preferred | Non-preferred | Nuvessa gel 1.3% |
| Antifungals, Topical | Clotrimazole solution Rx (topical) | Preferred | Non-preferred | Clotrimazole solution OTC (topical) |
| Antihistamines, 1st Generation | Diphenhydramine elixir (oral) | Preferred | Non-preferred | Diphenhydramine capsule, chew OTC, liquid OTC, tablet OTC |
| Colony Stimulating Factors | Fulphila (SQ) | Preferred | Non-preferred | Udenyca (SQ) |
| Colony Stimulating Factors | Granix syringe (injection) | Preferred | Non-preferred | Granix vial (injection), Neupogen syringe (injection) |
| Hematopoietic Agents | Nephron FA | Preferred | Non-preferred | Integra F |
| Hypoglycemics | Humulin pen OTC (SQ) | Preferred | Non-preferred | Humulin vial OTC (SQ) |
| Hypoglycemics | Humulin N KwikPen | Preferred | Non-preferred | Humulin N (injection) |
| Ophthalmic Agents | Moxeza | Preferred | Non-preferred | Ciprofloxacin sol 0.3% Ofloxacin sol 0.3% |
| Ophthalmic Agents | Lotemax | Preferred | Non-preferred | Prednisolone suspension 1% |
| Otic Antibiotics | Ciprofloxacin (otic) | Preferred | Non-preferred | Ofloxacin (otic) |
| Penicillins | Amoxicillin/Clav ER tablet | Preferred | Non-preferred | Amoxicillin/Clav tablet |
| Anticonvulsants | All medications | No status | Preferred | |
| Antipsychotics | Haloperidol decanoate (injection) | No status | Preferred | |
| Hemophilia Treatment | All medications | No status | Preferred | |
| HIV/AIDS | All medications | No status | Preferred | |
| Multiple Sclerosis Agents | All medications | No status | Preferred | |
| Oncology, Oral | All medications | No status | Preferred | |
| Anti-Allergens, Oral | Palforzia maintenance sachet/titration capsule (oral) | No status | Non-preferred | |
| Antihistamines, 1st Generation | Miclara LQ OTC (oral) | No status | Non-preferred | |
| Antimigraine Agents | Ajovy autoinjector (SQ) | No status | Non-preferred | Emgality pen, 120mg syringe (SQ) |
| Antimigraine Agents | Nurtec (oral) | No status | Non-preferred | Ubrelvy tablet (oral) |
| Antipsychotics | Caplyta (oral) | No status | Non-preferred | Aripiprazole tablet (oral), ziprasidone capsule (oral) |
| Antipsychotics | Fluphenazine decanoate (injection) | No status | Non-preferred | |
| Antipsychotics | Geodon (intramusc) | No status | Non-preferred | |
| Antipsychotics | Haldol decanoate (intramusc) | No status | Non-preferred | |
| Antipsychotics | Haloperidol lactate (injection) | No status | Non-preferred | Haloperidol lactate conc (oral) |
| Antipsychotics | Olanzapine (intramusc) | No status | Non-preferred | Olanzapine ODT or tablet (oral) |
| Antipsychotics | Zyprexa (intramusc) | No status | Non-preferred | Ziprasidone capsule (oral) |
| Bone Resorption Suppression | Teriparatide (Brand) (SQ) | No status | Non-preferred | |
| Dermatologics | Azelaic acid | No status | Non-preferred | Metronidazole gel |
| Dermatologics | Ivermectin | No status | Non-preferred | Metronidazole gel |
| Hepatitis C Agents | Harvoni pellet pack (oral) | No status | Non-preferred | |
| Hepatitis C Agents | Sovaldi pellet pack (oral) | No status | Non-preferred | |
| Hypoglycemics | Trijardy XR (oral) | No status | Non-preferred | |
| Hypoglycemics | Lyumjev 100, 200 u/ml pen, vial (SQ) | No status | Non-preferred | Humalog |
| Hypoglycemics | Riomet ER suspension (oral) | No status | Non-preferred | Metformin ER (oral) |
| Immune Globulins | Hizentra syringe (SQ) | No status | Non-preferred | |
| Immunomodulators, Atopic Dermatitis | Dupixent pen (SQ) | No status | Non-preferred | |
| Lipotropics | Nexlizet (oral) | No status | Non-preferred | |
| Lipotropics | Nexletol (oral) | No status | Non-preferred | |
| Sedative Hypnotics | Dayvigo (oral) | No status | Non-preferred | |
| Antihistamines, 1st Generation | Cyproheptadine tablet (oral) | Non-preferred | Preferred | |
| Antihistamines, 1st Generation | Pediaclear PD drops, Pediaclear-8 liquid OTC (oral) | Non-preferred | Preferred | |
| Antimigraine Agents | Ubrelvy tablet (oral) | Non-preferred | Preferred | |
| Antiparasitics, Topical | Vanalice gel OTC (topical) | Non-preferred | Preferred | |
| GI Motility, Chronic | Amitiza (oral) | Non-preferred | Preferred | |
| Hypoglycemics | Januvia (oral) | Non-preferred | Preferred | |
| Macrolides/
Ketolides |
Eryped 200, 400 suspension (oral) | Non-preferred | Preferred | |
| NSAIDs | Diclofenac gel (topical), Diclofenac potassium (oral) | Non-preferred | Preferred | |
| NSAIDs | Naproxen EC (oral) | Non-preferred | Preferred | |
| Otic Antibiotics | Ofloxacin (otic) | Non-preferred | Preferred | |
| Tetracyclines | Doxycycline hyclate capsule (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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