Provider Alert! Medicaid Preferred Drug List and Formulary ChangesTexas Children's Health Plan
Date: July 21, 2023
Attention: All Providers
Effective Date: July 27, 2023
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 27, 2023, select medication(s) moved from “preferred” to “non-preferred” status. A summary of the changes is included below.
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.
|Sumatriptan Kit||Antimigraine agents||Imitrex Kit [B] *|
|Gvoke syringe [B]||Glucagon agents||Gvoke pen [B], Baqsimi [B], Glucagon [G]|
|Zegalogue [B]||Glucagon agents||Gvoke pen [B] , Baqsimi [B] , Glucagon [G]|
|Ryaltris [B]||Intranasal Rhinitis Agents||Combination preferred antihistamine/corticosteroid therapy (e.g., azelastine & fluticasone)^|
|Tetrabenazine||Movement disorders||Ingrezza [B] *, Xenazine [B] *, Austedo [B] *|
|Tadliq suspension [B]||PAH agents||Adcirca oral tablets [B] ^|
|Dyanavel XR tablet [B]||Stimulants and related agents||Dyanavel XR suspension [B] *|
|Xelstrym [B]||Stimulants and related agents||Dextroamphetamine IR tablets [G]|
|Quillichew ER||Stimulants and related agents||Cotempla XR-ODT [B] *|
|Entadfi [B]||BPH treatments||Finasteride [G] ^|
|Fylnetra [B]||Colony Stimulating factors||Nyvepria [B]|
|Skyrizi On-Body [B]||Cytokine and Cam Antagonists||Enbrel [B]^ Humira [B]^|
|Sotyktu [B]||Cytokine and Cam Antagonists||Otezla [B]^|
|Pradaxa pellet pack (oral) [B]||Anticoagulant||Pradaxa [B]|
|Venlafaxine Besylate ER (ORAL)||Antidepressant||Venlafaxine ER capsules (oral) [G]|
|Valganciclovir tablet (ORAL) [G]||Antiviral||Valcyte tablet [B]|
|Amjevita Autoinjector HC (SQ) [B]||TNF inhibitor||Humira [B] *|
|Amjevita Autoinjector LC (SQ) [B]||TNF inhibitor||Humira [B] *|
|Amjevita Syringe (SQ) [B]||TNF inhibitor||Humira [B] *|
|Firazyr (SQ) [B]||HAE Treatments||Icatibant *|
|Tezspire Pen (SQ)||Anti-Asthmatic||Xolair [B] *|
|Protopic (TOPICAL) [B]||Immunomodulator for atopic dermatitis||Tacrolimus [G]|
|Noxafil Suspdr PKT (ORAL)||Antifungal||Noxafil (posaconazole) tablet [B]|
|Rolvedon Syringe (SQ) [B]||Colony Stimulating Factor||Granix [B], Neupogen [B], Nyvepria [B] ^|
|Stimufend Syringe (SQ) [B]||Colony Stimulating Factor||Nyvepria [B]|
|BasaglarTempo Pen (SQ) [B]||Antidiabetic||Lantus Solostar 100 unit/ML [B]|
|Humalog Tempo Pen (SQ) [B]||Antidiabetic||Humalog Kwikpen [B]|
|Lyumjev Tempo Pen (SQ) [B]||Antidiabetic||Humalog Kwikpen [B]|
*In addition to PDL, these medications also have a clinical prior authorization requirement.
^This is a suggested preferred alternative. Please discuss these options with your provider to determine therapy.
[B] Signals the medication is brand name.
[G] Signals the medication is generic.
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. 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. TCHP encourages providers to initiate a preferred medication to members new to therapy. When possible, TCHP 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.