Provider Alert! Medicaid drug formulary changes

Provider Alert!

Provider Alert! Medicaid drug formulary changes

Date: January 26, 2021
Attention: All Providers

Effective Date: January 28, 2021

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, January 28, 2021. 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.

PDL Drug Class Medication Current Status Status effective Jan 28, 2021 Medications on Preferred Drug List
Antibiotics, Vaginal Metronidazole (vaginal) Preferred Non-preferred Nuvessa gel 1.3%
Antifungals, Topical Clotrimazole solution Rx (topical) Preferred Non-preferred Clotrimazole solution OTC (topical)
Antihistamines, 1st Generation Diphenhydramine elixir (oral) Preferred Non-preferred Diphenhydramine capsule, chew OTC, liquid OTC, tablet OTC
Colony Stimulating Factors Fulphila (SQ) Preferred Non-preferred Udenyca (SQ)
Colony Stimulating Factors Granix syringe (injection) Preferred Non-preferred Granix vial (injection), Neupogen syringe (injection)
Hematopoietic Agents Nephron FA Preferred Non-preferred Integra F
Hypoglycemics Humulin pen OTC (SQ) Preferred Non-preferred Humulin vial OTC (SQ)
Hypoglycemics Humulin N KwikPen Preferred Non-preferred Humulin N (injection)
Ophthalmic Agents Moxeza Preferred Non-preferred Ciprofloxacin sol 0.3% Ofloxacin sol 0.3%
Ophthalmic Agents Lotemax Preferred Non-preferred Prednisolone suspension 1%
Otic Antibiotics Ciprofloxacin (otic) Preferred Non-preferred Ofloxacin (otic)
Penicillins Amoxicillin/Clav ER tablet Preferred Non-preferred Amoxicillin/Clav tablet
Anticonvulsants All medications No status Preferred  
Antipsychotics Haloperidol decanoate (injection) No status Preferred  
Hemophilia Treatment All medications No status Preferred  
HIV/AIDS All medications No status Preferred  
Multiple Sclerosis Agents All medications No status Preferred  
Oncology, Oral All medications No status Preferred  
Anti-Allergens, Oral Palforzia maintenance sachet/titration capsule (oral) No status Non-preferred  
Antihistamines, 1st Generation Miclara LQ OTC (oral) No status Non-preferred  
Antimigraine Agents Ajovy autoinjector (SQ) No status Non-preferred Emgality pen, 120mg syringe (SQ)
Antimigraine Agents Nurtec (oral) No status Non-preferred Ubrelvy tablet (oral)
Antipsychotics Caplyta (oral) No status Non-preferred  Aripiprazole tablet (oral), ziprasidone capsule (oral)
Antipsychotics Fluphenazine decanoate (injection) No status Non-preferred  
Antipsychotics Geodon (intramusc) No status Non-preferred  
Antipsychotics Haldol decanoate (intramusc) No status Non-preferred  
Antipsychotics Haloperidol lactate (injection) No status Non-preferred Haloperidol lactate conc (oral)
Antipsychotics Olanzapine (intramusc) No status Non-preferred Olanzapine ODT or tablet (oral)
Antipsychotics Zyprexa (intramusc) No status Non-preferred Ziprasidone capsule (oral)
Bone Resorption Suppression Teriparatide (Brand) (SQ) No status Non-preferred  
Dermatologics Azelaic acid No status Non-preferred Metronidazole gel
Dermatologics Ivermectin No status Non-preferred Metronidazole gel
Hepatitis C Agents Harvoni pellet pack (oral) No status Non-preferred  
Hepatitis C Agents Sovaldi pellet pack (oral) No status Non-preferred  
Hypoglycemics Trijardy XR (oral) No status Non-preferred  
Hypoglycemics Lyumjev 100, 200 u/ml pen, vial (SQ) No status Non-preferred Humalog
Hypoglycemics Riomet ER suspension (oral) No status Non-preferred Metformin ER (oral)
Immune Globulins Hizentra syringe (SQ) No status Non-preferred  
Immunomodulators, Atopic Dermatitis Dupixent pen (SQ) No status Non-preferred  
Lipotropics Nexlizet (oral) No status Non-preferred  
Lipotropics Nexletol (oral) No status Non-preferred  
Sedative Hypnotics Dayvigo (oral) No status Non-preferred  
Antihistamines, 1st Generation Cyproheptadine tablet (oral) Non-preferred Preferred  
Antihistamines, 1st Generation Pediaclear PD drops, Pediaclear-8 liquid OTC (oral) Non-preferred Preferred  
Antimigraine Agents Ubrelvy tablet (oral) Non-preferred Preferred  
Antiparasitics, Topical Vanalice gel OTC (topical) Non-preferred Preferred  
GI Motility, Chronic Amitiza (oral) Non-preferred Preferred  
Hypoglycemics Januvia (oral) Non-preferred Preferred  


Eryped 200, 400 suspension (oral) Non-preferred Preferred  
NSAIDs Diclofenac gel (topical), Diclofenac potassium (oral) Non-preferred Preferred  
NSAIDs Naproxen EC (oral) Non-preferred Preferred  
Otic Antibiotics Ofloxacin (otic) Non-preferred Preferred  
Tetracyclines Doxycycline hyclate capsule (oral) Non-preferred Preferred  


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