Date: January 18, 2024
Attention: All Providers
Effective Date: January 26, 2024
This is an update for a communication that was previously posted on 12/18/2023.
Call to action: Texas Children’s Health Plan (TCHP) would like to let providers know that effective January 26, 2024, select medication(s) moved from “preferred” or “non-reviewed” 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 |
| Accrufer [B] | NR to NPD | Iron, oral | |
| Clemastine Syrup [G] | NR to NPD | Antihistamine | Cyproheptadine Syrup [G] ^ |
| Cosentyx Unoready Pen (SQ) [B] | NR to NPD | Cytokine and Cam Antagonists | Cosentyx Syringe [G]* |
| Cyltezo (SQ) [B] | NR to NPD | Cytokine and Cam Antagonists | Humira [B] ^ *, Otezla [B] ^ *, Enbrel [B] ^ * |
| Eryped 200 Suspension [B] | PDL to NPD | Macrolides/Ketolides | Erythromycin Suspension [G] |
| Fiasp Pumcart (SQ) [B] | NR to NPD | Insulin | Fiasp Flextouch Pen [B] * , Insulin Aspart Pen [G] *, Fiasp Penfill [B] * |
| Konvomep (ORAL) [B] | NR to NPD | Proton Pump Inhibitor | Protonix (pantoprazole) suspension [B] |
| Latuda (ORAL) [B] | PDL to NPD | Antipsychotics | Olanzapine [G] ^ *, Ziprasidone [G] ^ * |
| Miebo (OPTH) [B] | NR to NPD | Eye Drops | Restasis [B] ^ *, Xiidra [B] ^ * |
| Ngenla (SQ) [B] | NR to NPD | Growth Hormone | Omnitrope [B] ^ *, Skytrofa [B] ^ * |
| Noxafil (ORAL) [B] | PDL to NPD | Antibiotics | Posaconazole [G] |
| Rezvoglar (SQ) [B] | NR to NPD | Insulin | Lantus Solostar Pen (SQ) [B] |
| Sogroya (SQ) [B] | NR to NPD | Growth Hormone | Omnitrope [B] ^ *, Skytrofa [B] ^ * |
| Udenyca (SQ) [B] | NR to NPD | Colony Stimulating Factor | Nyvepria [B] ^ * |
| Verkazia (OPTH) [B] | NR to NPD | Eye Drops | Restasis [B] * |
| Vigamox (OPTH) [B] | PDL to NPD | Eye Drops Antibiotics | Moxifloxacin (OPTH) [G]* |
*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.
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.