Provider Alert! Lidocaine 5% Patch Added To PDL

Provider Alert!

Provider Alert! Lidocaine 5% Patch Added To PDL

Date: April 21, 2023
Attention: All Providers

Effective Date: April 3, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to inform providers that effective April 3, 2023, the Texas Health and Human Services Commission (HHSC) temporarily removed the non-preferred status from the generic product, Lidocaine 5% patches on the preferred drug list (PDL). The preferred status of the brand name products (NDC 63481-0687-06) will not change to allow for any existing stock available to be utilized. This is in response to drug shortage for Lidoderm patches (PDL) due to discontinuation of the product by the manufacturer.

Please see below the NDC for Lidocaine 5% patch that will be recognized on the PDL.

NDCGeneric Drug Name
00378905593Lidocaine 5% patch
00591352530Lidocaine 5% patch
00603188016Lidocaine 5% patch
16714017730Lidocaine 5% patch
42858011830Lidocaine 5% patch
65162079108Lidocaine 5% patch

How this impacts providers: The change will allow providers to prescribe the generic lidocaine patches without requiring a PDL prior authorization. Providers will be able to continue prescribing necessary medication to their patients.

NOTE: This change is temporary. HHSC will further assess the availability of any alternative brand name products in the Neuropathic Pain PDL class. HHSC will provide further announcements regarding future PDL status changes when information becomes available.

Next steps for providers: Prescribers are encouraged to proactively obtain a prescription for the preferred agents.

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

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