Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Provider Alert!

Provider Alert! Medicaid Preferred Drug List and Formulary Changes

Date: December 18, 2023

Attention: Providers

Effective Date: January 25, 2024

Call to action: Texas Children’s Health Plan (TCHP) would like to notify providers that effective January 26, 2024, select medication(s) moved from “preferred” or “non-reviewed” to “non-preferred” status. A summary of the changes is included below.


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.

Impacted MedicationStatus ChangeTypePreferred Alternative
Abilify Asimtufi (IM)NR to NPDAntipsychoticsAbilify Maintena [B]* ^
Accrufer [B]NR to NPDIron, oral 
Clemastine Syrup  [G]NR to NPDAntihistamineCyproheptadine Syrup [G] ^
Cosentyx (SQ) [B]NR to NPDCytokine and Cam AntagonistsHumira [B] ^ *, Otezla [B] ^ *, Enbrel [B] ^ *
Cyltezo (SQ) [B]NR to NPDCytokine and Cam AntagonistsHumira [B] ^ *, Otezla [B] ^ *, Enbrel [B] ^ *
Eryped Suspension [B]PDL to NPDMacrolides/KetolidesErythromycin Suspension [G]
Fiasp (SQ) [B]NR to NPDInsulinInsulin Aspart Pen [G] *
Invega Hafyera (IM) [B]PDL to NPDAntipsychoticsInvega Sustenna (IM) [B] ^ *
Invega Trinza (IM) [B]PDL to NPDAntipsychoticsInvega Sustenna (IM) [B] ^ *
Konvomep (ORAL) [B]NR to NPDProton Pump InhibitorProtonix (pantoprazole) suspension [B]
Latuda (ORAL) [B]PDL to NPDAntipsychoticsOlanzapine [G] ^ *, Ziprasidone [G] ^ *
Miebo (OPTH) [B]NR to NPDEye DropsRestasis [B] ^ *, Xiidra [B] ^ *
Ngenla (SQ) [B]NR to NPDGrowth HormoneOmnitrope [B] ^ *, Skytrofa [B] ^ *
Noxafil (ORAL) [B]PDL to NPDAntibioticsPosaconazole [G]
Rezvoglar (SQ) [B]NR to NPDInsulinLantus Solostar Pen (SQ) [B]
Sogroya (SQ) [B]NR to NPDGrowth HormoneOmnitrope [B] ^ *, Skytrofa [B] ^ *
Udenyca (SQ) [B]NR to NPDColony Stimulating FactorNyvepria [B] ^ *
Uzedy (SQ) [B]NR to NPDAntipsychoticPerseris [B] ^ *
Verkazia  (OPTH) [B]NR to NPDEye DropsRestasis [B] *
Vigamox (OPTH) [B]PDL to NPDEye Drops AntibioticsMoxifloxacin (OPTH) [G]*

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

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

[B] Signals the medication is brand.

[G] Signals the medication is generic.

NR stands for Not Reviewed

PDL stands for Preferred Drug List

NPD stands for Non-Preferred Drug

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. 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:

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