Alinia (Nitazoxanide) Formulary Change

Date: October 18, 2021 Attention: All Providers Effective date: November 23, 2021Providers should monitor the Texas Children’s Health Plan (TCHP) Provider Portal regularly for alerts and updates associated to the COVID-19 event. TCHP reserves the right to update and/or change this information without prior notice due to the evolving nature of the COVID-19 event. Call to action: The Texas Vendor Drug Program (VDP) will be removing Alinia Suspension and tablet from the list of covered products effective November 23^rd 2021. Nitazoxanide tablets will be exclusively covered on Medicaid formulary and access will require prior authorization. Prior authorization criteria stay the same, but VDP will remove indications associated with Alinia suspension. How this impacts providers: A prior authorization of therapy will be approved for members who meet the following criteria:

Does the client have a diagnosis of giardiasis or cryptosporidiosis in the past 90 days?

[ ] Yes (Go to #2) [ ] No (Deny)

Is the client greater than or equal to (≥) 12 years of age?

[ ] Yes (Go to #3) [ ] No (Deny)

Is the dose less than or equal to (£) 1,000 mg per day?

[ ] Yes (Approve – 30 days) [ ] No (Deny)

Next steps for providers: Prescribers should adjust their prescribing patterns accordingly and communicate these changes to their staff. For patients who require Alinia suspension, prescribers should email the Pharmacy department at: tchppharmacy@texaschildrens.org. Requests to the exception of coverage should include the medical necessity for Alinia Suspension. Resource: https://paxpress.txpa.hidinc.com/aliniapdg.pdf For access to all provider alerts, log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers. If you have any questions, please email the Pharmacy department at: tchppharmacy@texaschildrens.org.