Semi-annual Medicaid Preferred Drug List Update Coming July 29

Published on
June 17, 2021

Texas Medicaid will perform the semi-annual update of the Medicaid preferred drug list on July 29. HHSC made the PDL changes based on recommendations made at the January and April 2021 Texas Drug Utilization Review Board meetings. Drug list recommendations and decisions from those meetings are available.

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 will be posted by July 26 to reflect the recent changes.
  • The Preferred Drug List Criteria Guide (PDF) outlines the criteria used to evaluate the non-preferred prior authorization requests. It will be updated by July 26 to reflect the recent changes.

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 summarize noteworthy changes for the July PDL update based on the Jan. 2021 PDL decisions (PDF).

PDL Class Drug Current PDL Status Recommended Status
Angiotensin Modulators

Epaned Solution (Oral)

Non-Preferred

Preferred

Antimigraine Agents, Triptans

 

Imitrex (Nasal)

Non-Preferred

Preferred

Antimigraine Agents, Triptans

 

Sumatriptan Kit (Sun) (Subcutane.)

Non-Preferred

Preferred

Antiparkinson’s Agents

Apokyn (Subcutaneous)

Not Reviewed

Non-Preferred

Antiparkinson’s Agents

Kynmobi (Sublingual)

Not Reviewed

Non-Preferred

Antiparkinson’s Agents

Ongentys (Oral)

Not Reviewed

Non-Preferred

H. Pylori Treatment

Talicia (Oral)

Not Reviewed

Non-Preferred

Movement Disorders

Tetrabenazine (Oral)

Non-Preferred

Preferred

Oncology, Oral – Breast

All Drugs

Preferred

 Preferred

Oncology, Oral – Hematologic

 

All Drugs

Preferred

 Preferred

Oncology, Oral – Lung

 

All Drugs

Preferred

 Preferred

Oncology, Oral – Other

 

All Drugs

Preferred

 Preferred

Oncology, Oral – Prostate

 

All Drugs

Preferred

 Preferred

Oncology, Oral – Renal Cell

 

All Drugs

Preferred

 Preferred

 

Oncology, Oral – Skin

 

All Drugs

Preferred

 Preferred

 

Stimulants and Related Agents

Adderall XR (Oral)

Non-Preferred

Preferred

Stimulants and Related Agents

Amphetamine Salt Combo EE (Ag) (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Amphetamine Salt Combo ER (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Aptensio XR (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Concerta (Oral)

Non-Preferred

Preferred

Stimulants and Related Agents

Dexmethylphenidate ER (Ag) (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Dexmethylphenidate ER (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Focalin XR (Oral)

Non-Preferred

Preferred

Stimulants and Related Agents

Jornay PM (Oral)

Non-Preferred

Preferred

Stimulants and Related Agents

Methylphenidate ER (Concerta) (AG) (Oral)

Preferred

Non-Preferred

Stimulants and Related Agents

Wakix (Oral)

Not Reviewed

Non-Preferred

Cytokine and Cam Antagonists

Enbrel Vial (Subcutaneous)

Not Reviewed

Preferred

Cytokine and Cam Antagonists

Enspryng (Subcutaneous)

Not Reviewed

Non-Preferred

Multiple Sclerosis Agents

 

Bafiertam Capsule Dr (Oral)

Not Reviewed

Preferred

Multiple Sclerosis Agents

 

Kesimpta (Subcutane.)

Not Reviewed

Preferred

The second table summarize noteworthy changes for the July PDL update based on the April 2021 PDL recommendations (PDF).

PDL Class Drug Current PDL Status Recommended Status
Antibiotics, Inhaled Arikayce (Inhalation) Preferred Non-Preferred

Anticoagulants

Fragmin Disp Syrin (Subcutane)

Preferred

Non-Preferred

Antivirals, Oral

Relenza (Inhalation)

Preferred

Non-Preferred

Bronchodilators, Beta Agonist

Ventolin Hfa (Inhalation)

Non-Preferred

Preferred

Copd Agents

Anoro Ellipta (Inhalation)

Non-Preferred

Preferred

Copd Agents

Bevespi Aerosphere (Inhalation)

Preferred

Non-Preferred

Erythropoiesis Stimulating Proteins

Epogen (Injection)

Preferred

Non-Preferred

Glucocorticoids, Inhaled

Budesonide 0.25, 0.5 Mg Respules (Inhalation)

Non-Preferred

Preferred

Glucocorticoids, Inhaled

Budesonide 1 Mg Respules (Inhalation)

Non-Preferred

Preferred

Glucocorticoids, Inhaled

Pulmicort 0.25, 0.5 Mg Respules (Inhalation)

Preferred

Non-Preferred

Glucocorticoids, Inhaled

Pulmicort 1 Mg Respules (Inhalation)

Preferred

Non-Preferred

HAE Treatments

Firazyr (Sub-Q)

Preferred

Non-Preferred

HAE Treatments

Icatibant (Subcut)

Non-Preferred

Preferred

HAE Treatments

Orladeyo (Oral)

Non-Reviewed

Non-Preferred

Hemophilia Treatment

Sevenfact (Intraven)

Non-Reviewed

Preferred

Hypoglycemics, Incretin Mimetics/Enhancers

Janumet (Oral)

Non-Preferred

Preferred

Hypoglycemics, Incretin Mimetics/Enhancers

Trulicity (Subcutane)

Non-Preferred

Preferred

Lipotropics, Other

Omega-3 Acid Ethyl Esters (Oral)

Non-Preferred

Preferred

Multiple Sclerosis Agents

Dimethyl Fumarate Dr (Ag) (Oral)

Not Reviewed

Preferred

Multiple Sclerosis Agents

Mayzent Dose Pack (Oral)

Not Reviewed

Preferred

Multiple Sclerosis Agents

Plegridy (Intramusc.)

Not Reviewed

Preferred

Pediatric Vitamin Preparations

Aquadeks Drops Otc (Oral)

Not Reviewed

Preferred

Pediatric Vitamin Preparations

Children's Vitamins with Iron Chew OTC (Oral)

Not Reviewed

Non-preferred

Pediatric Vitamin Preparations

Poly-Vi-Sol Drops OTC (Oral)

Not Reviewed

Preferred

Pediatric Vitamin Preparations

Poly-Vi-Sol with Iron Drops OTC (Oral)

Not Reviewed

Preferred

Prenatal Vitamins

Citranatal B-Calm (Oral)

Preferred

Non-preferred

Prenatal Vitamins

Vitafol Tab Chew (Oral)

Non-Preferred

Preferred

Sickle Cell Anemia Treatments

Endari (Oral)

Non-Preferred

Preferred

Sickle Cell Anemia Treatments

Oxbryta (Oral)

Non-Preferred

Preferred

Sickle Cell Anemia Treatments

Siklos (Oral)

   Non-Preferred

Preferred

Thrombopoiesis Stimulating Proteins

Promacta Suspension (Oral)

Preferred

Non-preferred

Colony Stimulating Factors

Nyvepria (Subcutaneous)

Not Reviewed

Non-preferred

Ophthalmics For Allergic Conjunctivitis

Pataday Xs Once Daily OTC (Ophthalmic)

Not Reviewed

Preferred