Provider Alert! Medicaid drug formulary changes

Provider Alert!

Provider Alert! Medicaid drug formulary changes

Attention: All Providers
Effective Date: July 31, 2020

Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event.  TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event.

Call to action: The Texas Vendor Drug Program (VDP) will implement changes to the state Medicaid drug formulary, effective Thursday, July 30, 2020. Select medications will be moving from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wanted to notify you in advance 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.

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.

Generics or alternatives with similar strengths/formulations available as preferred

PDL Drug Class Medication Current Status Status effective July 30, 2020 Medications on Preferred Drug List
Stimulants Adderall XR 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg (oral) Preferred Non-preferred* Dextroamphetamine / Amphethamine ER 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg
Stimulants Jornay PM No status Non-preferred* Methylphenidate CD, ER, LA
Anticonvulsants Lyrica capsule, solution (oral) Preferred Non-preferred* Pregabalin capsule, solution
Antidepressants, SSRI Fluoxetine 60 mg (oral) Preferred Non-preferred* Fluoxetine 20 mg, 40 mg tablets
Antivirals, Oral/Nasal Tamiflu capsule (oral) Preferred Non-preferred* Oseltamivir capsule
PAH Agents, Oral and Inhaled Letairis (oral) Preferred Non-preferred* Ambrisentan
Antiparkinson’s Agents Bromocriptine (oral) Preferred Non-preferred Amantadine, Benztropine, Carbidopa/Levodopa, Pramipexole, Ropinirole, Trihexyphenidyl
Prenatal Vitamins Citranatal DHA (oral) Preferred Non-preferred Citranatal 90 DHA,  Citranatal Assure,

Citranatal B-Calm,  Citranatal Harmony,  Citranatal Rx

Trinatal Rx 1

Prenatal Vitamins Vol-Plus (oral) Preferred Non-preferred Vitafol-OB

Vitafol Ultra

Amino Acids Endari powder No status Non-preferred
Antidiabetic Agents Rybelsus No status Non-preferred Ozempic
Antihypoglycemia Agents Gvoke Hypopen, Gvoke PFS No status Non-preferred Glucagen, Glucagon
Antimigraine Agents Ubrelvy No status Non-preferred Aimovig, Ajovy, Emgality
Sickle Cell Siklos, Oxbryta No status Non-preferred Droxia, Hydrea, hydroxyurea
Stimulants Dextroamphetamine / Amphethamine ER (oral) Non-preferred Preferred
Antidepressants, Other Venlafaxine (oral) Non-preferred Preferred
Antivirals, Oral/Nasal Valcyte (solution) Non-preferred Preferred
Lipotropics, Other Fenofibrate capsule (Lofibra) (oral) Non-preferred Preferred
Lipotropics, Statins Rosuvastatin (oral) Non-preferred Preferred
PAH Agents, Oral and Inhaled Ambrisentan (oral),

Revatio suspension (oral)

Non-preferred Preferred
Sedative Hypnotics Eszopiclone (oral), Zaleplon (oral) Non-Preferred Preferred
Tardive Dyskinesia Ingrezza (oral) Non-Preferred Preferred

 If you have questions, please contact us at

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