Provider Alert! Promethazine Update

Provider Alert!

Provider Alert! Promethazine Update

Date: December 7, 2021

Attention: Primary Care Providers

Effective Date: December 7, 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: Texas Medicaid revised the Promethazine/Promethazine containing clinical prior authorization criteria by removing the Generic Code Numbers (GCN) for promethazine containing cough and cold products. Prior authorization criteria stay the same, but HHSC removed the following GCNs from the Promethazine/Promethazine Containing Products guide:

GCN Drug name
13977 Promethazine VC syrup
13978 Promethazine VC-codeine syrup
13971 Promethazine-codeine syrup
13975 Promethazine-DM syrup

Additionally, the title of clinical prior authorization criteria will change to Promethazine Agents.

How this impacts providers: The cough and cold criteria guide contain criteria for promethazine VC syrup (13977) and promethazine-DM syrup (13975). However, promethazine VC-codeine syrup (13978) and promethazine-codeine syrup (13971) are not included in the cough and cold criteria guide. These agents contain codeine and are not intended for patients less than 18 years of age.

Next steps for providers: Providers should share this update with their staff as well.


1. Navitus TX Medicaid Prior Authorization Forms

If you have any questions, please email TCHP Pharmacy Department at:

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