Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: September 14, 2022

Attention: All Providers

Effective Date: July 28, 2022

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated with 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: Texas Children’s Health Plan (TCHP) would like to inform providers that the Texas Vendor Drug Program (VDP) implemented changes to the state Medicaid drug formulary, effective July 28, 2022. Select medication(s) moved from “preferred” to “non-preferred” status and vice-versa. TCHP would like 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/2022/semi-annual-medicaid-preferred-drug-list-update-coming-july-28

Changes with biggest impact to TCHP members and providers:

*Some example IR/ER ADHD agents on preferred list include but not limited to Adderall XR, Concerta, Daytrana, Dyanavel XR, Focalin XR, Jornay PM, Methylin solution, Quillichew ER, Quillivant XR and Vyvanse.

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. TCHP encourages providers to initiate a preferred medication to members new to therapy. When possible, TCHP 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:
http://www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.