Provider Alert! Updated: Medicaid Preferred Drug List and Formulary Changes

Date: January 18, 2024

Attention: All Providers

Effective Date: January 26, 2024

This is an update for a communication that was previously posted on 12/18/2023.

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know 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.

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.

Impacted Medication	Status Change	Type	Preferred Alternative
Accrufer [B]	NR to NPD	Iron, oral
Clemastine Syrup  [G]	NR to NPD	Antihistamine	Cyproheptadine Syrup [G] ^
Cosentyx Unoready Pen (SQ) [B]	NR to NPD	Cytokine and Cam Antagonists	Cosentyx Syringe [G]*
Cyltezo (SQ) [B]	NR to NPD	Cytokine and Cam Antagonists	Humira [B] ^ *, Otezla [B] ^ *, Enbrel [B] ^ *
Eryped 200 Suspension [B]	PDL to NPD	Macrolides/Ketolides	Erythromycin Suspension [G]
Fiasp Pumcart (SQ) [B]	NR to NPD	Insulin	Fiasp Flextouch Pen [B] * , Insulin Aspart Pen [G] *, Fiasp Penfill [B] *
Konvomep (ORAL) [B]	NR to NPD	Proton Pump Inhibitor	Protonix (pantoprazole) suspension [B]
Latuda (ORAL) [B]	PDL to NPD	Antipsychotics	Olanzapine [G] ^ *, Ziprasidone [G] ^ *
Miebo (OPTH) [B]	NR to NPD	Eye Drops	Restasis [B] ^ *, Xiidra [B] ^ *
Ngenla (SQ) [B]	NR to NPD	Growth Hormone	Omnitrope [B] ^ *, Skytrofa [B] ^ *
Noxafil (ORAL) [B]	PDL to NPD	Antibiotics	Posaconazole [G]
Rezvoglar (SQ) [B]	NR to NPD	Insulin	Lantus Solostar Pen (SQ) [B]
Sogroya (SQ) [B]	NR to NPD	Growth Hormone	Omnitrope [B] ^ *, Skytrofa [B] ^ *
Udenyca (SQ) [B]	NR to NPD	Colony Stimulating Factor	Nyvepria [B] ^ *
Verkazia  (OPTH) [B]	NR to NPD	Eye Drops	Restasis [B] *
Vigamox (OPTH) [B]	PDL to NPD	Eye Drops Antibiotics	Moxifloxacin (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 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.org

For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.