Provider Alert! Medicaid drug formulary changesTexas Children's Health Plan
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: https://www.txvendordrug.com/formulary/prior-authorization/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.
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
|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)
|Sedative Hypnotics||Eszopiclone (oral), Zaleplon (oral)||Non-Preferred||Preferred|
|Tardive Dyskinesia||Ingrezza (oral)||Non-Preferred||Preferred|
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