Update to Semi-Annual Medicaid PDL to Be Published on July 28, 2025

Date: July 17, 2025 

Attention: Providers 

Call to action: The purpose of this communication is to inform providers that Texas Medicaid will publish the updated semi-annual Medicaid Preferred Drug List (PDL) on July 28, 2025.

How this impacts providers:

Preferred Drug Reminders

• Prescribing providers must use the Medicaid formulary and the PDL.
• Providers that prescribe medications for clients enrolled in the Children’s Health Insurance Program (CHIP) must use the CHIP formulary.
  • CHIP does not have a PDL.
• The PDL does not include all the drugs on the Texas Medicaid formulary.
• Drugs on the Texas Medicaid formulary are designated as preferred, non-preferred, or having neither designation.
• The PDL includes only preferred or non-preferred drugs. The following applies to the Texas Medicaid formulary and PDL:
  • Drugs that are not designated as preferred or non-preferred are available without prior authorization.
  • Drugs on the PDL that are identified as non-preferred will require prior authorization.
  • Some preferred and non-preferred drugs may require clinical prior authorization.
  • Certain drugs on the Medicaid formulary and the PDL are subject to one or both types of prior authorization, namely clinical and non-preferred. Prescribing providers must obtain prior authorization for these drugs. Pharmacy staff may not request prior authorizations.

Obtaining Medicaid Outpatient Drug Prior Authorization

• Prescribing providers must obtain prior authorization for outpatient drugs based on what Medicaid program a client is enrolled in.
• For clients enrolled in a Medicaid managed care organization (MCO), prescribing providers or their representatives should contact the prior authorization call center that is unique to the client’s MCO. · Prior authorization call center phone numbers vary by MCO. Prescribers should use the MCO Search to find each MCO’s prior authorization call center phone numbers.
• For clients in traditional Medicaid, prescribing providers or their representatives should call the Texas Prior Authorization Call Center at 877-PA-TEXAS (877-728-3927) or submit the request online using the VDP Provider Portal.

Online Drug Reference Information 

• The Medicaid and CHIP formulary and Medicaid PDL are available online.
• Formulary information is also available for all state programs administered by the Texas Health and Human Services Commission (HHSC). · Providers can download the free subscription drug information service called epocrates to their computer or mobile device.
• In addition to listing a drug’s preferred status, epocrates includes drug monographs, dosing information, and warnings.
• All prescribing providers are eligible to register for epocrates online. Refer to section 9.1.1 of the Outpatient Drug Services Handbook in the Texas Medicaid Provider Procedures Manual to learn more.
• Prescribing providers can use their e-prescribing software to view the Medicaid and CHIP formularies or to find preferred drugs and alternatives to non-preferred medications.

72-Hour Emergency Supply

• Prescribing providers must obtain prior authorization before the client submits the prescription.
• Pharmacy staff will alert the prescribing provider if approval has not been obtained when the prescription is presented to the pharmacy.
  • If the client needs medication without delay, pharmacy staff can provide a 72-hour emergency supply of the medication while the prescribing provider obtains prior authorization.
  • Dispensing an emergency supply offers the person an immediate dose of the medicine, but they must return to the pharmacy to collect the entire prescription or receive alternative therapy.

Pharmacy Prior Authorization Quick Course 

To learn more about Medicaid outpatient pharmacy benefits, including prior authorization, refer to A Prescriber’s Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization.

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 Provider Relations at:providerrelations@texaschildrens.org. 

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