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National Drug Codes Added to Medicaid, CHIP Formularies
Date: May 16, 2024
Attention: Providers
Effective date: May 8 and May 10, 2024
Call to action: Texas Children’s Health Plan would like to inform providers that the Vendor Drug Program added the new drugs to the table available below, effective May 8, 2024, and May 10, 2024.
| National Drug Code | Drug Name | Effective Date |
| 00173090442 | NUCALA 40 MG/0.4 ML SYRINGE | 5/8/2024 |
| 15370030560 | POKONZA 10 MEQ PACKET | 5/8/2024 |
| 64406003002 | ZURZUVAE 25 MG CAPSULE | 5/10/2024 |
| 64406003101 | ZURZUVAE 30 MG CAPSULE | 5/10/2024 |
| 68682013350 | CLINDAMYC-BNZ PEROX 1.2-3.7 | 5/10/2024 |
| 72786010202 | OXBRYTA 300 MG TABLET | 5/10/2024 |
| 72786010203 | OXBRYTA 300 MG TABLET | 5/10/2024 |
| 72205018138 | PIRFENIDONE 267 MG TABLET | 5/10/2024 |
| 59651020623 | NITROFURANTOIN 25 MG/5 ML SUSP | 5/10/2024 |
| 00173089713 | JESDUVROQ 1 MG TABLET | 5/10/2024 |
| 00173090313 | JESDUVROQ 2 MG TABLET | 5/10/2024 |
| 00173090613 | JESDUVROQ 4 MG TABLET | 5/10/2024 |
| 00173091113 | JESDUVROQ 6 MG TABLET | 5/10/2024 |
| 00173091413 | JESDUVROQ 8 MG TABLET | 5/10/2024 |
| 64406002901 | ZURZUVAE 20 mg | 5/10/2024 |
Next step for Providers: Providers should make note of the additions of the new drugs and share this communication with their staff.
If you have any questions, please email Provider Relations at: providerrelations@texaschildrens.org.
For access to all provider alerts,log into:
www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.