Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Provider Alert!

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: January 25, 2022

Attention: All Providers

Subject: Medicaid Preferred Drug List and Formulary Changes

Effective Date: January 27, 2022

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) implemented changes to the state Medicaid drug formulary, effective Thursday, January 27, 2022. Select medication(s) moved from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wanted to notify providers 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.

Resources:

https://www.txvendordrug.com/about/news/2021/semi-annual-medicaid-preferred-drug-list-update-coming-january-27

https://www.txvendordrug.com/about/news/2022/january-2022-preferred-drug-list-now-available.

Changes with biggest impact to Texas Children Health Plan members and providers:

 

PDL Drug Class Medication Previous status New status effective 1/27/22 Alternatives or other comments
Antibiotics, GI Aemcolo (oral) [B] NR NPD Consider generic formulation and/or other antibiotics (GI) on PDL
Antiemetic/antivertigo agents Gimoti (nasal) [B] NR NPD Consider generic formulation and/or other antiemetic/antivertigo agents on PDL
Antifungals, oral Brexafemme (oral) NR NPD Various generic antifungals (oral) on PDL
Antifungals, topical Triamazole kit (topical) NR NPD Various generic antifungals (topical) on PDL
Antivirals, topical Acyclovir ointment (topical) PDL NPD Zovirax ointment [B] is preferred.
Colony stimulating factors Udenyca (subcutaneous) [B] PDL NPD
Macrolides/ketolides Eryped 200 suspension (oral) [B] PDL NPD Consider generic formulation and/or other macrolide/ketolides (oral) on PDL
Glucagon agents Zegalogue autoinjector (subcutaneous) [B] NR NPD Consider generic formulation and/or other glucagon agents on PDL
Glucagon agents Zegalogue syringe (subcutaneous) [B] NR NPD Consider generic formulation and/or other glucagon agents on PDL
Immunosuppressives Benlysta autoinjector (subcutane.) [B] NR NPD
Immunosuppressives Benlysta syringe (subcutane.) [B] NR NPD
Immunosuppressives Lupkynis (oral) [B] NR NPD

 

*indicates the generic is now preferred and the brand is non-preferred

[B] Indicates the brand drug

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 (link below). 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.

If you have any questions, please email TCHP Pharmacy Department at: tchppharmacy@texaschildrens.org.

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

Resources:

https://www.txvendordrug.com/formulary/prior-authorization/preferred-drugs.

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