Medicaid Preferred Drug List and Formulary Changes

Date: July 11, 2024

Attention: Providers

Effective Date: August 8, 2024

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective August 8, 2024, 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.

Impacted Medication	Status Change	Type	Preferred Alternative
CABTREO (Topical) [B]	NR→ NPD	ACNE AGENTS	DUAC (Topical) [B] [D], EPIDUO FORTE (Topical) [B] [D]
ZMA CLEAR CLEANSER (TOPICAL) [B]	NR→ NPD	ACNE AGENTS	DUAC (Topical) [B] [D], EPIDUO FORTE (Topical) [B] [D]
EPANED SOLUTION (ORAL) [B]	PDL→ NPD	ANGIOTENSIN MODULATORS	ENALAPRIL SOLUTION (ORAL)[G]
OXYBUTYNIN 2.5MG (ORAL) [G]	NR→ NPD	BLADDER RELAXANT PREPARATIONS	OXYBUTYNIN IR (ORAL), OXYBUTYNIN ER (ORAL)
VESICARE (ORAL) [B]	PDL→ NPD	BLADDER RELAXANT PREPARATIONS	SOLIFENACIN (ORAL) [G]
GVOKE PEN (SUBCUTANEOUS) [B]	PDL→ NPD	GLUCAGON AGENTS	ZEGALOGUE AUTOINJECTOR (SUBCUTANEOUS) [B] ^{^}, ZEGALOGUE SYRINGE (SUBCUTANEOUS) [B] ^{^}
XENAZINE (ORAL) [B]	PDL→ NPD	MOVEMENT DISORDERS	TETRABENAZINE [G]*
DERMACINRX LIDOCAN PATCH (TOPICAL) [B]	NR→ NPD	NEUROPATHIC PAIN	LIDOCAINE (TOPICAL) [G] ^{^}*
LIDOCAN II (TOPICAL) [B]	NR→ NPD	NEUROPATHIC PAIN	LIDOCAINE (TOPICAL) [G] ^{^}*
XYLIDERM (TOPICAL) [B]	NR→ NPD	NEUROPATHIC PAIN	LIDOCAINE (TOPICAL) [G]^{^} *
LIQREV SUSPENSION (ORAL) [B]	NR→ NPD	PAH AGENTS, ORAL AND INHALED	REVATIO (ORAL) [B] ^{^}*
ORENITRAM TITRATION KIT (ORAL) [B]	NR→ NPD	PAH AGENTS, ORAL AND INHALED	REVATIO (ORAL) [B] [D]*
XPHOZAH TABLET (ORAL) [B]	NR→ NPD	PHOSPHATE BINDERS	RENAGEL (ORAL) [B] [D], RENVELA (ORAL) [B] [D]
RELEXXII (ORAL) [B]	NR→ NPD	STIMULANTS AND RELATED AGENTS	JORNAY PM (ORAL) [B] ^ , CONCERTA (ORAL) [B]^{^}
RYKINDO (IM) [B]	NR→ NPD	ANTIPSYCHOTICS	RISPERDOL CONSTA (IM) [B] ^{^} *
ADALIMUMAB-ADBM KIT (INJECTION) (CF) 50 MG/ML [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] *
ADALIMUMAB-ADBM PEN KIT (INJECTION) (CF) 50 MG/ML (SQ) [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B]*
ENTYVIO PEN (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
JESDUVROQ TABLET (ORAL) [B]	NR→ NPD	ERYTHROPOIESIS STIMULATING PROTEINS	ARANESP (SUBCUTANEOUS) [B] [D], EPOGEN (SUBCUTANEOUS, IV) [B] [D], , RETACRIT (IV) [B] [D] *,
AIRSUPRA HFA (INHALATION) [B]	NR→ NPD	GLUCOCORTICOIDS, INHALED	SYMBICORT (INHALATION) [B] [D]*
ZURZUVAE (ORAL) [B]	NR→ NPD	ANTIDEPRESSANTS, OTHER	BUPROPRION (ORAL) [G] [D], MIRTAZAPINE (ORAL) [G] [D], SERTRALINE (ORAL) [G] [D]
COLCRYS (ORAL) [B]	PDL→ NPD	ANTIHYPERURICEMICS	MITIGARE (ORAL) [B]
VALCYTE TABLET (ORAL) [B]	PDL→ NPD	ANTIHYPERURICEMICS	VALGANCICLOVIR (ORAL) [G]
ABRILADA (ADALIMUMAB-AFZB) HW 50MG/ML (SUBCUTANEOUS) [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B]*
ABRILADA (ADALIMUMAB-AFZB) LW 50 MG/ML (SUBCUTANEOUS) [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B]*
ADALIMUMAB-AACF 50 MG/ML (SUBCUTANEOUS) [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B]*
AMJEVITA (ADALIMUMAB-ATTO) 100 MG/ML (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] *
BIMZELX (BIMEKIZUMAB-BKZX) (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
COSENTYX IV (SECUKINUMAB) (INTRAVENOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
LITFULO (ORAL) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
OMVOH (INJECTION) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
YUFLYMA SYRINGE (INJECTION) (CF) 100 MG/ML [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
ZYMFENTRA (INFLIXIMAB-DYYB) (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUIMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
ZETIA (ORAL) [B]	PDL→ NPD	LIPOTROPICS, OTHER	EZETIMIBE (ORAL) [G]
ATORVALIQ (ORAL SUSP) [B]	NR→ NPD	LIPOTROPICS, STATINS	ATORVASTATIN (ORAL TAB) [G] ^{^}
FLURAZEPAM (ORAL)	PDL→ NPD	SEDATIVE HYPNOTICS	LORAZEPAM (ORAL) [G] ^{^} , DIAZEMPAM (ORAL) [G] ^{^}
ALVAIZ (ORAL) [B]	NR→ NPD	THROMBOPOIESIS STIMULATING PROTEINS	PROMACTA (ORAL) [B] [D]*
OLPRUVA (ORAL) [B]	NR→ NPD	UREA CYCLE DISORDERS, ORAL	BUPHENYL (ORAL) [B] ^{^}*
LIKMEZ SUS (ORAL) [B]	NR→ NPD	ANTIBIOTICS, GASTROINTESTINAL	METRONIDZOLE (ORAL) [G] ^{^}
VEVYE (OPHTHALMIC) [B]	NR→ NPD	OPHTHALMICS, ANTI-INFLAMMATORY IMMUNOMODULATORS	RESTASIS (OPHTHALMIC) [B] ^{^}*
VELSIPITY (ORAL) [B]	NR→ NPD	ULCERATIVE COLITIS	DELZICOL (ORAL) [B] [D], LIALDA (ORAL) [B] [D], SULFASALAZINE (ORAL) [G] [D]

*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
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.

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.