Medicaid Preferred Drug List and Formulary Changes

Date: July 23, 2026

Attention: Providers

Effective date: July 24, 2026

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 24, 2026, 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.

*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.

[D] No direct alternative agent and/or comparable agent as a suitable recommendation, defer to physician’s decision.

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 step 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 TCHP Pharmacy Department at: TCHPPharmacy@texaschildrens.org.

For access to all provider alerts www.texaschildrenshealthplan.org/provideralerts