Provider Alert! Medicaid Preferred Drug List and Formulary ChangesTexas Children's Health Plan
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.
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: firstname.lastname@example.org.