If you are Texas Children’s Health Plan Member, we have tips that can help you deal with the severe weather. Learn more
Si eres miembro de Texas Children’s Health Plan, tenemos consejos que pueden ayudarte a lidiar con el clima severo. Aprende Más
Medicaid Preferred Drug List and Formulary Changes
Date: July 30, 2021
Attention: All Providers
Effective Date: July 29, 2021Providers 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) implemented changes to the state Medicaid drug formulary, effective Thursday, July 29, 2021. Select medications moved from “preferred” to “non-preferred” status and vice-versa. Texas Children’s Health Plan wanted to notify providers 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.
Resources: https://www.txvendordrug.com/about/news/2021/july-2021-preferred-drug-list-now-available.
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 (link below). 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.
If you have any questions, please email Provider Network Management at: tchppharmacy@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
Resources:https://www.txvendordrug.com/formulary/prior-authorization/preferred-drugs.
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 (link below). 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.
If you have any questions, please email Provider Network Management at: tchppharmacy@texaschildrens.org.For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.
Resources:https://www.txvendordrug.com/formulary/prior-authorization/preferred-drugs.