Provider Alert! Medicaid Preferred Drug List and Formulary Changes
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.
Resource: https://www.txvendordrug.com/formulary/preferred-drugs
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.
Medication | Type | Preferred Alternative |
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.