Texas Children's Health Plan will be closed on Monday, May 26th, in observance of Memorial Day. In our absence, you can reach our after-hours nurse help line at 1-800-686-3831. We will resume normal business hours on Tuesday, May 27th. Wishing you a safe and happy Memorial Day weekend!
Texas Children’s Health Plan estará cerrado el lunes 26 de mayo por el feriado. Durante nuestra ausencia, puede comunicarse con nuestra línea telefónica de ayuda 24/7 fuera del horario de atención al 1-800-686-3831. Reanudaremos nuestro horario habitual el martes 27 de mayo. ¡Le deseamos un fin de semana festivo seguro y feliz!
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Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 26, 2024, select medication(s) moved from “preferred” or “non-reviewed” 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.
*In addition to PDL, these medications also have a clinical prior authorization requirement. ^This is a suggested alternative. Please discuss these options with your provider to determine therapy. [B] Signals the medication is brand. [G] Signals the medication is generic. NR stands for Not Reviewed PDL stands for Preferred Drug List NPD stands for Non-Preferred Drug
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 https://www.txvendordrug.com/formulary/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.
