Semi-annual Medicaid Preferred Drug List Update Coming January 27

Published on
December 8, 2021

HHSC will publish the semi-annual update of the Medicaid preferred drug list on January 27. HHSC made the PDL changes based on recommendations made at the July and November 2021 Texas Drug Utilization Review Board meetings. Drug list decisions the July meeting and recommendations from the November meeting are available.

As a reminder, drugs with preferred status drugs may include brand name medication which would not require a PDL prior authorization nor the value of "1" in the "Dispense as Written (DAW) Product Selection code" field (4Ø8-D8). Refer to the Dispense as Written section of the Drug Policy chapter of the Pharmacy Provider Procedure Manual for more information.

The first table below includes the January PDL update changes from the July PDL decisions.

PDL Class Drug Current PDL Status Recommended Status
Immunosuppressives, oral Rapamune tablet (oral) Non-Preferred Preferred
Immunosuppressives, oral Sirolimus tablet (AG) (oral) Preferred Non-Preferred
Immunosuppressives, oral Sirolimus tablet (oral) Preferred Non-Preferred
Ophthalmics, anti-inflammatories Lotemax drops (ophthalmic) Non-Preferred Preferred
Ophthalmics, anti-inflammatory/immunomodulators Xiidra (ophthalmic) Non-Preferred Preferred
Platelet Aggregation Inhibitors Aggrenox (oral) Preferred Non-Preferred
Platelet Aggregation Inhibitors Aspirin/Dipyridamole (oral) Non-Preferred Preferred
Stimulants and related agents Qelbree (oral) Non-Reviewed Preferred

The second table includes the January PDL from the November PDL recommendations.

PDL Class Drug Current PDL Status Recommended Status
Anticonvulsants Elepsia XR tablet (oral) Non-Reviewed Preferred
Anticonvulsants Rufinamide suspension (oral) Non-Reviewed Preferred
Anticonvulsants Rufinamide tablet (oral) Non-Reviewed Preferred
Antipsychotics Perseris (subcutaneous) Non-Preferred Preferred
Antipsychotics Vraylar (oral) Non-Preferred Preferred
Hypoglycemics, Insulin, and Related Agents Insulin Aspart cartridge (AG) (subcutaneous) Preferred Non-Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart vial (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart/Insulin Aspart Protamine insulin pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart/Insulin Aspart Protamine vial (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro Junior Kwikpen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro Protamine Mix Kwikpen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro vial (AG) (subcutaneous) Non-Preferred Preferred
Opiate Dependence Treatments Kloxxado spray (nasal) Non-Reviewed Preferred
Glucagon Agents Zegalogue autoinjector (subcutaneous) Non-Reviewed Non-Preferred
Glucagon Agents Zegalogue syringe (subcutaneous) Non-Reviewed Non-Preferred
Immunosuppressives Benlysta autoinjector (subcutane) Non-Reviewed Non-Preferred
Immunosuppressives Benlysta Syringe (subcutane) Non-Reviewed Non-Preferred
Immunosuppressives Lupkynis (oral) Non-Reviewed Non-Preferred
Oncology, Oral-Lung Lumakras (oral) Non-Reviewed Preferred
Oncology, Oral-Other Truseltiq (oral) Non-Reviewed Preferred

HHSC designates drugs on the Texas Medicaid formulary 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.
  • HHSC will publish the preferred drug list will be posted by January 24 to reflect the recent changes.
  • The Preferred Drug List Criteria Guide (PDF) outlines the criteria used to evaluate the non-preferred prior authorization requests. HHSC will update the guide by January 24 to reflect the recent changes.