Medicaid Preferred Drug List and Formulary Changes

Date: January 3, 2025

Attention: All Providers

Effective Date: January 30, 2025

Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 30, 2025, 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

Impacted Medication	Status Change	Type	Preferred Alternative
ADALIMUMAB-ADBM 100MG/ML PEN KIT (SUBCUTANEOUS) ) [G] ADALIMUMAB-ADBM 100MG/ML SYRINGE KIT (SUBCUTANEOUS) [G]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B] *
ADBRY AUTOINJECTOR (SUBCUTANEOUS) [B]	NR→ NPD	IMMUNOMODULATOR	ELIDEL (Topical) [B] [D], EUCRISA (TOPICAL) [B] [D] , TACROLIMUS (TOPICAL) [G] [D] *,
AGAMREE SUSPENSION (ORAL) [B]	NR→ NPD	DUCHENNE MUSCULAR DYSTROPHY AGENT	PREDNISONE SOLUTION (ORAL) [B] [D] , DEXMETHASONE SOLUTION (ORAL) [B] [D]
CLINDESSE CREAM (VAGINAL) [B]	PDL→ NPD	ANTIBIOTICS	CLEOCIN OVULES (VAGINAL) [B]
CYLTEZO 100MG/ML PEN KIT (SUBCUTANEOUS) [B] CYLTEZO 100MG/ML SYRINGE KIT (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B]*
ENTRESTO SPRINKLE CAPSULE (ORAL) [B]	NR→ NPD	ANGIOTENSIN MODULATOR	LOSARTAN (ORAL) [G][D]
EOHILIA (ORAL) [B]	NR→ NPD	GLUCOCORTICOID	BUDESONIDE EC (ORAL) [G][D]
FLUTICASONE PROPIONATE (AG) (INHALATION) [G]	NR→ NPD	GLUCOCORTICOID INHALER	QVAR(INHALATION) [B] [D] *
INVOKAMET (ORAL) [B] INVOKAMET XR (ORAL) [B]	PDL→ NPD	ANTIDIABETIC AGENT	SYNJARDY (ORAL) [B][D] , XIGDUO XR (ORAL) [B][D]
INVOKANA (ORAL) [B]	PDL→ NPD	ANTIDIABETIC AENT	FARXIGA (ORAL) [B][D] , JARDIANCE (ORAL) [B][D]
IQIRVO TABLET (ORAL) [B]	NR→ NPD	BILE SALTS	URSODIOL (ORAL) [G] [D]
KLAYESTA POWDER (TOPICAL) [B]	PDL→ NPD	ANTIFUNFAL	NYAMYC (TOPICAL) [B] , NYSTOP(TOPICAL) [B]
LEVEMIR FLEXPEN (SUBCUTANEOUS) [B] LEVEMIR FLEXTOUCH (SUBCUTANEOUS) [B] LEVEMIR VIAL (SUBCUTANEOUS) [B]	PDL→ NPD	ANTIDIABETIC	LANTUS (SUBCUTANEOUS) [B] [D]
LIALDA (ORAL) [B]	PDL→ NPD	ULCERATIVE COLITIS AGENT	DELZICOL (ORAL) [B] [D], PENTASA (ORAL) [B] [D]
MYCOZYL AP POWDER (TOPICAL) [B]	PDL→ NPD	ANTIFUNGAL	NYAMYC (TOPICAL) [B] [D], NYSTOP(TOPICAL) [B] [D]
MYHIBBIN SUSPENSION (ORAL) [B]	NR→ NPD	IMMUNOSUPRESSION	MYCOPHENOLATE MOFETIL CAPSULES, TABLETS (ORAL) [G] [D]
NAPROSYN SUSPENSION (ORAL) [B]	NR→ NPD	NSAIDS	NAPROXEN TABLETS (ORAL) [G][D]
OMVOH PFS (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
ONDANSETRON ODT 16 MG (ORAL) [G]	NR→ NPD	ANTIEMETIC-ANTIVERTIGO AGENTS	ONDANSETRON ODT 8 MG [G] [D]
OPSYNVI (ORAL) [B]	NR→ NPD	PULMONARY HYPERTENSION AGENT	ADCIRCA (ORAL) [B] [D]*
RINVOQ LQ SOLUTION (ORAL) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
SIMLANDI (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANE) [B]*
SITAGLIPTIN/METFORMIN TABLET (ORAL) [G]	NR→ NPD	ANTIDIABETIC	JANUMET XR (ORAL) [B]*
SITAGLIPTIN TABLET (AG ZITUVIO) (ORAL) [G]	NR→ NPD	ANTIDIABETIC	JANUVIA (ORAL) [B]*
SPEVIGO (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
TAZTIA XT CAPSULE EXTENDED RELEASE 24 HOUR (ORAL) [B]	PDL→ NPD	BLOOD PRESSURE AGENT	DILTIAZEM ER (ORAL) [B]
TIADYLT ER CAPSULE EXTENDED RELEASE 24 HOUR (ORAL) [B]	PDL→ NPD	BLOOD PRESSURE AGENT	DILTIAZEM ER (ORAL) [B]
TRIPENICOL CREAM (TOPICAL) [B] TRIPENICOL SOLUTION (TOPICAL) [B]	NR→ NPD	ANTIFUNGAL	NYAMYC (TOPICAL) [B] [D], TERBINAFINE (TOPICAL) [G] [D]
TYENNE (SUBCUTANEOUS) [B]	NR→ NPD	CYTOKINE AND CAM ANTAGONISTS	HUMIRA (SUBCUTANEOUS) [B] [D], OTEZLA (SUBCUTANEOUS) [B] [D], ENBREL (SUBCUTANEOUS) [B] [D]*
UDENYCA ONBODY (SUBCUTANEOUS) [B]	NR→ NPD	COLONY SITMULATING FACTOR	NYVEPRIA (SUBCUTANEOUS) [B] [D]
ZITUVIO TABLET (ORAL) [B]	NR→ NPD	ANTIDIABETIC AGENT	JANUVIA (ORAL) [B]*
ZORYVE 0.15% CREAM (TOPICAL) ZORYVE 0.3% CREAM (TOPICAL) ZORYVE 0.3% FOAM (TOPICAL) [B]	NR→ NPD	ATOPIC DERMATITIS AGENT	EUCRISA (TOPICAL) [B] [D]*

_{*In addition to PDL, these medications also have a clinical prior authorization requirement.}
_{[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. TCHP encourages providers to initiate a preferred medication to members new to therapy. When possible, TCHP also encourages switching existing members to a preferred agent.

If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.

For access to all provider alerts,log into: www.texaschildrenshealthplan.org/provideralerts.