Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Provider Alert!

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: December 29, 2022

Attention: Providers

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:

MedicationTypePreferred alternatives
Ciproflaxacin suspension [G]AntibioticCipro suspension [B]
E.E.S. (erythromycin) granules [G]AntibioticEryped 200 suspension [B]
Fleqsuvy [B]Muscle relaxerBaclofen [G], carisoprodol* [G], cyclobenzaprine [G],
 methocarbamol [G], tizanidine [G]
Fulphila [B]Bone marrow/stem cellNyvepria [B]
Ibsrela [B]IBS/constipationAmitiza [B] *, Linzess [B]*, Movantik [B]*
Lastacaft [B]Allergies (eyes)Cromolyn [B], Olopatadine over-the-counter (OTC) once-daily drops [G]
Livtencity [B]CMVValcyte solution [B]; valganciclovir tablets [G]
Mesalamine [G]Ulcerative colitis/Chron’sCanasa [B]
Metformin extended release [G]DiabetesGlumetza [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 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: or

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