Date: July 25,2025
Attention: Providers
Effective date: July 28, 2025
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective July 28, 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-RYVK(CF) SYRGINGE (SUBCUTANEOUS) [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HUMIRA (SUBCUTANEOUS) [B] * |
| CATAPRES-TTS (TRANSDERM) PATCH [B] | PDL→NPD | ANTIHYPERTENSIVES, SYMPATHOLYTICS | CLONIDINE TRANDERMAL PATCH [G] |
| CIMZIA 200 MG/ML SYRINGE KIT (SUBCUTANEOUS) [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HADLIMA PUSHTOUCH (SUBCUTANEOUS) AUTO INJCT [B] [D]* |
| COBENFY CAPSULE (ORAL) [B] | NR→NPD | ANTIPSYCHOTICS | VRAYLAR (ORAL) [B] [D] *, REXULTI (ORAL) [B] [D] * |
| COBENFY CAPSULE, STARTER PACK (ORAL) [B] | NR→NPD | ANTIPSYCHOTICS | VRAYLAR (ORAL) [B] [D] *, REXULTI (ORAL) [B] [D] * |
| CREXONT (ORAL) CAP IR ER [B] | NR→NPD | ANTIPARKINSON'S AGENTS (ORAL/TRANSDERMAL) | CARBIDOPA/LEVODOPA ER (ORAL) [G] |
| DEXILANT (ORAL) CAP DR BP [B] | PDL→NPD | PROTON PUMP INHIBITORS | NEXIUM (ORAL) [D], OMEPRAZOLE (ORAL) [G] |
| EBGLYSS PEN INJECTOR (SUBCUTANEOUS) [B] | NR→NPD | IMMUNOMODULATORS, ATOPIC DERMATITIS | TACROLIMUS (TOPICAL) [G] [D]* |
| EPIDUO FORTE (TOPICAL) GEL W/PUMP [B] | PDL→NPD | ACNE AGENTS, TOPICAL | BENZOYL PEROXIDE/CLINDAMYCIN (DUAC) (TOPICAL) [B] [D] * |
| IDACIO(CF) PEN 40 MG/0.8 ML (SUBCUTANEOUS) [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HADLIMA PUSHTOUCH (SUBCUTANEOUS) AUTO INJCT [B] [D] * |
| LIVDELZI CAPSULE (ORAL) [B] | NR→NPD | BILE SALTS | URSODIOL (ORAL) [G] [D] |
| NEMLUVIO AUTO-INJECTOR [B] | NR→NPD | IMMUNOMODULATORS, ATOPIC DERMATITIS | TACROLIMUS (TOPICAL) [G] [D]* |
| OHTUVAYRE AMPUL-NEB (INHALATION) [B] | NR→NPD | COPD AGENTS | ROFLUMILAST (ORAL) [G] [D]* |
| OMVOH INJ 100/200 AUTOINJ [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HUMIRA (SUBCUTANEOUS) [B] [D]*, HADLIMA PUSHTOUCH (SUBCUTANEOUS) AUTO INJCT [B] [D]*, RINVOQ (ORAL) [B] [D]* |
| OMVOH INJ 100/200 PFS [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HUMIRA (SUBCUTANEOUS) [B] [D]*, HADLIMA PUSHTOUCH (SUBCUTANEOUS) AUTO INJCT [B] [D]*, RINVOQ (ORAL) [B] [D]* |
| ONYDA XR (ORAL) SUS ER 24H [B] | NR→NPD | STIMULANTS AND RELATED AGENTS | CLONIDINE (TRANSDERMAL) [G] [D]* |
| OPIPZA (ORAL) [B] | NR→NPD | ANTIPSYCHOTICS | ARIPIPRAZOLE TABLET (ORAL) [G] [D]* |
| OTULFI PFS [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | HADLIMA PUSHTOUCH (SUBCUTANEOUS) AUTO INJCT [B] [D]* |
| PRALUENT PEN (SUBCUT) PEN INJCTR [B] | PDL→NPD | LIPOTROPICS, OTHER | REPATHA (SUBCUTANEOUS) [B] [D]* |
| RIVAROXABAN (ORAL) TABLET [G] | PDL→NPD | ANTICOAGULANTS | ELIQUIS (ORAL) [B] [D]* |
| STEQEYMA PFS [B] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | SKYRIZI PEN (SUBCUTANEOUS) PEN INJECTOR [B] [D]* |
| TRAMADOL 25MG (ORAL) TABLET [B] | NR→NPD | ANALGESICS, NARCOTICS SHORT | TRAMADOL 50 MG (ORAL) TABLET |
| TRAMADOL 75MG (ORAL) TABLET [B] | NR→NPD | ANALGESICS, NARCOTICS SHORT | TRAMADOL 50 MG (ORAL) TABLET |
| USTEKINUMAB-TTWE PFS [G] | NR→NPD | CYTOKINE AND CAM ANTAGONISTS | SKYRIZI PEN (SUBCUTANEOUS) PEN INJECTOR [B] [D]* |
| VAFSEO TABLET (ORAL) [B] | NR→NPD | ERYTHROPOIESIS STIMULATING PROTEINS | ARANESP (SUBCUTANEOUS) [B] [D]* |
| VALCYTE (ORAL) SOLN RECON [B] | PDL→NPD | ANTIVIRALS (ORAL/NASAL) | VALGANCICLOVIR (ORAL) SOLUTION [G] |
| VOQUEZNA DUAL PAK (ORAL) [B] | NR→NPD | H. PYLORI TREATMENT | PYLERA (ORAL) [B] [D]* |
| VOQUEZNA TABS (ORAL) [B] | NR→NPD | PROTON PUMP INHIBITORS | OMEPRAZOLE (ORAL) [G], PANTOPRAZOLE (ORAL) [G] |
| VOQUEZNA TRIP PAK (ORAL) [B] | NR→NPD | H. PYLORI TREATMENT | PYLERA (ORAL) [B] [D]* |
| VTAMA (TOPICAL) CREAM [B] | NR→NPD | IMMUNOMODULATORS, ATOPIC DERMATITIS | ELIDEL (TOPICAL) [B] [D]*, 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 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 TCHP Pharmacy at: TCHPPharmacy@texaschildrens.org.
For access to all provider alerts: www.texaschildrenshealthplan.org/provideralerts.