Medicaid drug formulary changes

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 Vitafol Ultra
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)	Non-preferred	Preferred
Sedative Hypnotics	Eszopiclone (oral), Zaleplon (oral)	Non-Preferred	Preferred
Tardive Dyskinesia	Ingrezza (oral)	Non-Preferred	Preferred

 If you have questions, please contact us at tchppharmacy@texaschildrens.org.

For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers