Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: July 21, 2023

Attention: All Providers

Effective Date: July 27, 2023

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below.

Resource: https://www.txvendordrug.com/formulary/preferred-drugs

Changes with biggest impact to Texas Children Health Plan members and providers:

The drugs listed below were either not previously reviewed (NR) and became non-preferred (NPD) or previously considered a preferred agent (PDL) but now have changed status to non-preferred.

Medication	Type	Preferred Alternative
Sumatriptan Kit	Antimigraine agents	Imitrex Kit [B] *
Gvoke syringe [B]	Glucagon agents	Gvoke pen [B], Baqsimi [B], Glucagon [G]
Zegalogue  [B]	Glucagon agents	Gvoke pen [B] , Baqsimi  [B] , Glucagon [G]
Ryaltris  [B]	Intranasal Rhinitis Agents	Combination preferred antihistamine/corticosteroid therapy (e.g., azelastine & fluticasone)^
Tetrabenazine	Movement disorders	Ingrezza [B] *, Xenazine [B]  *, Austedo [B] *
Tadliq suspension [B]	PAH agents	Adcirca oral tablets [B] ^
Dyanavel XR tablet [B]	Stimulants and related agents	Dyanavel XR suspension [B] *
Xelstrym [B]	Stimulants and related agents	Dextroamphetamine IR tablets [G]
Quillichew ER	Stimulants and related agents	Cotempla XR-ODT [B] *
Entadfi  [B]	BPH treatments	Finasteride [G] ^
Fylnetra [B]	Colony Stimulating factors	Nyvepria [B]
Skyrizi On-Body  [B]	Cytokine and Cam Antagonists	Enbrel [B]^ Humira [B]^
Sotyktu [B]	Cytokine and Cam Antagonists	Otezla [B]^
Pradaxa pellet pack (oral)  [B]	Anticoagulant	Pradaxa [B]
Venlafaxine Besylate ER (ORAL)	Antidepressant	Venlafaxine ER capsules (oral) [G]
Valganciclovir tablet (ORAL) [G]	Antiviral	Valcyte tablet [B]
Amjevita Autoinjector HC (SQ)  [B]	TNF inhibitor	Humira [B] *
Amjevita Autoinjector LC (SQ)  [B]	TNF inhibitor	Humira [B] *
Amjevita Syringe (SQ)  [B]	TNF inhibitor	Humira [B] *
Firazyr (SQ)  [B]	HAE Treatments	Icatibant *
Tezspire Pen (SQ)	Anti-Asthmatic	Xolair [B] *
Protopic (TOPICAL)  [B]	Immunomodulator for atopic dermatitis	Tacrolimus [G]
Noxafil Suspdr PKT (ORAL)	Antifungal	Noxafil (posaconazole) tablet [B]
Rolvedon Syringe (SQ)  [B]	Colony Stimulating Factor	Granix [B], Neupogen [B], Nyvepria [B] ^
Stimufend Syringe (SQ)  [B]	Colony Stimulating Factor	Nyvepria [B]
BasaglarTempo Pen (SQ)  [B]	Antidiabetic	Lantus Solostar 100 unit/ML [B]
Humalog Tempo Pen (SQ)  [B]	Antidiabetic	Humalog Kwikpen [B]
Lyumjev Tempo Pen (SQ)  [B]	Antidiabetic	Humalog Kwikpen [B]

*In addition to PDL, these medications also have a clinical prior authorization requirement.

^This is a suggested preferred alternative. Please discuss these options with your provider to determine therapy.

[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.” Non-preferred drugs on the formulary require prior approval and are only approved when there is clinical justification as to why the patient cannot use the preferred drug, including failure/side effects or contraindications to the preferred agents. This means that 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. 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:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.