June 28, 2017
Texas Medicaid will implement the semi-annual update of the Medicaid preferred drug list (PDL) on July 27, 2017. The update is based on changes presented at the Drug Utilization Review Board meetings in January and April 2017. The following drug classes are being added to the PDL:
- Ophthalmic, Anti-inflammatory/Immunomodulator
- Tricyclic Antidepressants
- Urea Cycle Disorder Medications
Review noteworthy changes happening in July. Not all drugs on the Texas Medicaid formulary are included on the PDL, and most drugs are identified as preferred or non-preferred. Drugs identified on the PDL as preferred, or not listed at all, are available to individuals without prior authorization. Drugs identified as non-preferred require a PDL prior authorization. In addition, clinical prior authorizations may apply to any individual drug or an entire drug class on the formulary, including some preferred and non-preferred drugs.
The PDL Criteria Guide (PDF) explains the criteria used to evaluate the PDL prior authorization requests, and will be updated by July 19. Please refer to the DUR Board documents for specific PDL changes for the new therapeutic classes.