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.