Provider Alert! Temporary Change in PDL Status for the Tetracyclines Drug Class

Provider Alert!

Provider Alert! Temporary Change in PDL Status for the Tetracyclines Drug Class

Date: January 24, 2022

Attention: Primary care providers

Effective Date: January 11, 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: HHSC is aware of a drug shortage for Vibramycin 25mg/5mL suspension in the Tetracyclines drug class because of the discontinuation of this product by Pfizer. In response to the shortage of the preferred brand product Vibramycin 25mg/5mL suspension, national drug code (NDC) 0069-0971-95, HHSC temporarily removed the non-preferred status from the generic product, doxycycline 25mg/5mL suspension, on the preferred drug list (PDL). HHSC removed the non-preferred status of the following drugs, effective January 11, 2022


NDC Drug Name
62135-0417-46 DOXYCYCLINE 25 MG/5 ML SUSP
68180-0657-01 DOXYCYCLINE 25 MG/5 ML SUSP
69097-0228-43 DOXYCYCLINE 25 MG/5 ML SUSP


How this impacts providers: These changes will allow providers to prescribe the generic doxycycline suspension without requiring a PDL prior authorization and continue accessing necessary medication for clients. HHSC’s change is temporary until the preferred products are sufficiently available in the market, and HHSC will provide further announcements regarding future PDL status changes for these NDCs.

Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and share this update with their staff as well

If you have any questions, please email Provider Network Management at:

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