Provider Alert! Medicaid Preferred Drug List and Formulary ChangesTexas Children's Health Plan
Date: December 29, 2022
Effective Date: January 26, 2023
Call to action: Effective January 26, 2023, select medication(s) moved from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wants 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:
|Ciproflaxacin suspension [G]||Antibiotic||Cipro suspension [B]|
|E.E.S. (erythromycin) granules [G]||Antibiotic||Eryped 200 suspension [B]|
|Fleqsuvy [B]||Muscle relaxer||Baclofen [G], carisoprodol* [G], cyclobenzaprine [G],|
methocarbamol [G], tizanidine [G]
|Fulphila [B]||Bone marrow/stem cell||Nyvepria [B]|
|Ibsrela [B]||IBS/constipation||Amitiza [B] *, Linzess [B]*, Movantik [B]*|
|Lastacaft [B]||Allergies (eyes)||Cromolyn [B], Olopatadine over-the-counter (OTC) once-daily drops [G]|
|Livtencity [B]||CMV||Valcyte solution [B]; valganciclovir tablets [G]|
|Mesalamine [G]||Ulcerative colitis/Chron’s||Canasa [B]|
|Metformin extended release [G]||Diabetes||Glumetza [B]|
|Olopatadine eye drops [G]||Allergies (eyes)||Cromolyn [B], Olopatadine OTC once-daily [G]|
|Takhzyro [B]||Hereditary angioedema||Berinert [B]*, Cinryze [B]* , Firazyr [B]*, Haegarda [B]*, Kalbitor [B]*|
* In addition to PDL, these medications also have a clinical prior authorization requirement.
[B] Signals the medication is brand name
[G] Signals the medication is generic.
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/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.
If you have any questions, please email TCHP Pharmacy Department at: TCHPPharmacy@texaschildrens.orgFor access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.