Guidance for Laxatives for Medicaid Members

Attention: All ProvidersEffective Date: September 3, 2020Providers 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: Polyethylene Glycol [PEG] 3350 (generic for Miralax), ClearLax (powdered formulation of PEG 3350) and generic lactulose are all laxatives on the Texas Medicaid drug formulary. These agents are equally safe and efficacious as Kristalose (brand formulation of lactulose) for STAR and CHIP members. TCHP encourages providers to consider prescribing PEG 3350, ClearLax (available as powder) or generic lactulose (available in solution) rather than the brand Kristalose (available in packets) when appropriate for members new to therapy.  TCHP also encourages switching current members from brand medications to generic alternatives when possible.  Providers should continue to consider patient-specific factors and use their professional judgement and expertise when switching from Kristalose to PEG 3350, ClearLax, or lactulose.A summary of laxatives is listed below:

Generic OTC	Brand OTC	Brand Rx
Polyethylene Glycol [PEG] 3350 powder ClearLax powder	lactulose solution	Kristalose packets

Next steps for providers: Providers should continue to follow American Academy of Pediatrics guidelines when prescribing and encouraged to consider the available generic agents in the laxative drug class for the appropriate health indications when prescribing. Reference: Philichi L (2018).  Management of childhood functional constipation.  Journal of Pediatric Health Care 32(1):  103-111.  https://doi.org/10.1016/j.pedhc.2017.08.008. If you have any questions, please email Provider Network Management at: providerrelations@texaschildrens.org.For access to all provider alerts,log into: www.thecheckup.org or www.texaschildrenshealthplan.org/for-providers.