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.