Medicaid Preferred Drug List and Formulary Changes July 2025

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.