December 17, 2020

Texas Medicaid will publish the semi-annual update of the Medicaid preferred drug list on Jan. 28. The update is based on changes presented and recommended at the July and Oct. 2020 Texas Drug Utilization Review Board meetings. Drug list decisions from those meetings are available. The tables below summarize noteworthy changes for the Jan. update.

New preferred drug classes:

  • July 2020
    • Rosacea Agents, topical
  • October 2020 (note: all drugs in the following PDL classes will have preferred status)
    • Anticonvulsants
    • Hemophilia Treatments
    • HIV/AIDS
    • Multiple Sclerosis Agents
    • Oncology, oral – Breast
    • Oncology, oral – Hematologic
    • Oncology, oral – Lung
    • Oncology, oral – Other
    • Oncology, oral – Prostate
    • Oncology, oral - Renal Cell
    • Oncology, oral – skin

Drugs on the Texas Medicaid formulary are designated as preferred, non-preferred, or have neither designation. The preferred drug list includes only drugs identified as either preferred or non-preferred:

  • Drugs not on the preferred list, or drugs identified on the list as "preferred", are available to people without prior authorization.
  • Drugs on the list identified as "non-preferred" will require prior authorization.
  • Some preferred and non-preferred drugs may require clinical prior authorization.
  • The Preferred Drug List Criteria Guide (PDF) outlines the criteria used to evaluate the non-preferred prior authorization requests. It will be updated by Jan. 25 to reflect the recent changes.

Decisions from July

Preferred Drug Class Drug Name Current Status Status as of January 28
Alzeimer’s Agents Exelon (Transderm.) Non-Preferred Preferred
Alzeimer’s Agents Rivastigmine (Ag) (Transderm.) Preferred Non-Preferred
Alzeimer’s Agents Rivastigmine (Transderm.) Preferred Non-Preferred
Antimigraine Agents Ajovy Autoinjector (Subcutaneous) No Status Non-Preferred
Antimigraine Agents Ubrelvy (Oral) Non-Preferred Preferred
Cephalosporins and Related Antibiotics Amoxicillin/Clav Xr (Oral) Preferred Non-Preferred
Non-Steroidal Anti-Inflammatory Drugs Diclofenac Gel (Topical) Non-Preferred Preferred
Non-Steroidal Anti-Inflammatory Drugs Diclofenac Potassium (Oral) Non-Preferred Preferred
Non-Steroidal Anti-Inflammatory Drugs Naproxen Ec (Oral) Non-Preferred Preferred
Otic Antibiotics Ciprofloxacin (Otic) Preferred Non-Preferred
Otic Antibiotics Ofloxacin (Otic) Non-Preferred Preferred
Anti-Allergens, Oral Palforzia Maintenance Sachet (Oral) No Status Non-Preferred
Anti-Allergens, Oral Palforzia Titration Capsule (Oral) No Status Non-Preferred
Antipsychotics Caplyta (Oral) No Status Non-Preferred
Hypoglycemics, Incretin Mimetics/Enhancers Trijardy Xr (Oral) No Status Preferred
Hypoglycemics, Metformins Riomet Er Suspension (Oral) No Status Non-Preferred
Immune Globulins Hizentra Syringe (Subcutaneous) No Status Non-Preferred
Lipotropics, Other Nexletol (Oral) No Status Non-Preferred

Decisions from Oct.

Preferred Drug Class Drug Name Current Status Status as of January 28
Antiparasitics, topical Vanalice Gel, OTC Non-Preferred Preferred
Antipsychotics Caplyta (oral) No Status Non-Preferred
Antipsychotics Fluphenazine Decanoate (injection) No Status Non-Preferred
Antipsychotics Haldol Decanoate (intrmusc) No Status Non-Preferred
Antipsychotics Haloperidol Decanoate (injection) No Status Preferred
Antipsychotics Geodon (intramusc) No Status Non-Preferred
Antipsychotics Haloperidol Lactate (injection) No Status Non-Preferred
Antipsychotics Olanzapine (intramusc) No Status Non-Preferred
Antipsychotics Zypreza (intramusc) No Status Non-Preferred
Colonly Stimluting Factors Fulphila (subcutaneous) Preferred Non-Preferred
Colony Stimlulating Factors Granix Syringe (injection) Preferred Non-Preferred
Gastrointestinal Motility, chronic Amitiza (oral) Non-Preferred Preferred
Hepatitis C Agents Harvoni Pellect Pack (oral) No Status Non-Preferred
Hepatitis C Agents Sovaldi Pellet Pack (oral) No Status Non-Preferred
Macrolides-Ketolides Eryped 200 Suspension (oral) Non-Preferred Preferred
Macrolides-Ketolides Eryped 400 Suspension (oral) Non-Preferred Preferred
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