Semi-annual Medicaid Preferred Drug List Update Coming July 28

Published on
June 16, 2022
  • Updated June 22, 2022

HHSC will publish the semi-annual update of the Medicaid preferred drug list on July 28. HHSC made the PDL changes based on recommendations made at the January and April 2022 Texas Drug Utilization Review Board meetings. Drug list decisions from the January and April meetings 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 (408-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 January PDL decisions. The second table includes the January PDL from the April PDL recommendations.

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  by July 25.
  • 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 July 25 to reflect the recent changes.
January PDL decisions
PDL Class Drug Current PDL Status Recommended Status
Analgesics, Narcotics Long Methadone Brand Sol Tablet (oral) Non-Reviewed Non-Preferred
Analgesics, Narcotics Long Tramadol ER (ryzolt) (oral) Non-Preferred Preferred
Antimigraine Agents, other Ajovy (subcutaneous) Non-Preferred Preferred
Antimigraine Agents, other Ajovy autoinjector (subcutaneous) Non-Preferred Preferred
Antimigraine Agents, other Ajovy autoinjector 3-pk (subcutaneous) Non-Reviewed Preferred
Antimigraine Agents, other Elyxyb solution (oral) Non-Reviewed Non-Preferred
Antimigraine Agents, other Nurtec ODT (oral) Non-Preferred Preferred
Antimigraine Agents, other Qulipta (oral) Non-Reviewed Non-Preferred
Antimigraine Agents, other Trudhesa (nasal) Non-Reviewed Non-Preferred
Antimigraine Agents, other Ubrelvy (oral) Preferred Non-Preferred
Glucagon Agents Gvoke syringe (subcutaneous) Non-Preferred Preferred
Glucagon Agents Zegalogue autoinjector (subcutaneous) Non-Preferred Preferred
Immunomodulators, atopic dermatitis Elidel (topical) Non-Preferred Preferred
Immunomodulators, atopic dermatitis Opzelura (topical) Non-Reviewed Non-Preferred
Immunomodulators, atopic dermatitis Protopic (topical) Non-Preferred Preferred
Neuropathic pain Lidoderm (topical) Non-Preferred Preferred
Neuropathic pain Lyrica capsule (oral) Non-Preferred Preferred
Neuropathic pain Pregabalin capsule (AG) (oral) Preferred Non-Preferred
Neuropathic pain Pregabalin capsule (oral) Preferred Non-Preferred
Potassium binders (new PDL class) Lokelma (oral) Non-Reviewed Preferred
Potassium binders (new PDL class) Sodium polystyrene sulfonate (oral) Non-Reviewed Preferred
Potassium binders (new PDL class) Veltassa (oral) Non-Reviewed Non-Preferred
Stimulants and related agents Azstarys (oral) Non-Reviewed Non-Preferred
Stimulants and related agents Qelbree (oral) Preferred Non-Preferred
Antipsychotics Invega Hafyera (intramusc) Non-Reviewed Preferred
Antipsychotics Lybalvi (oral) Non-Reviewed Non-Preferred
Immunosuppressives, oral Rezurock (oral) Non-Reviewed Non-Preferred
April PDL recommendations
PDL Class Drug Current PDL Status Recommended Status
Anticoagulants Xarelto suspension (oral) Non-reviewed Non-preferred
Antivirials,oral Valcyte tablet (oral) Preferred Non-preferred
Antivirials,oral Valganciclovir tablet (oral) Non-preferred Preferred
Erythropoiesis Stimulating Proteins Erythropoiesis stimulating proteins Non-preferred Preferred
Glucocorticoids, inhaled Pulmicort Flexhaler (inhalation) Non-preferred Preferred
Immune Globulins Cytogam (intraven) Preferred Non-preferred
Immune Globulins Gamastan S-D vial (intramusc) Preferred Non-preferred
Immune Globulins Hepagam B (intramusc) Preferred Non-preferred
Immune Globulins Hizentra vial (subcutaneous) Preferred Non-preferred
Immune Globulins Varizig (intramusc) Preferred Non-preferred
Immunomodulators, Asthma Xolair syringe (sub-q) Non-reviewed Preferred
Lincosamides/Oxazolidinones/Streptogramins Linezolid suspension (AG) (oral) Preferred Non-preferred
Lincosamides/Oxazolidinones/Streptogramins Linezolid suspension (oral) Preferred Non-preferred
Lipotropics, other Colestid tablet (oral) Non-preferred Preferred
Lipotropics, other Colestipol tablet (oral) Preferred Non-preferred
Lipotropics, statins Lipitor (oral) Non-preferred Preferred
Prenatal Vitamins Citranatal B-calm (oral) Non-preferred Preferred
Pulmonary Arterial Hypertension (PAH) agents, oral and inhaled Ambrisentan (oral) Preferred Non-preferred
PAH agents, oral and inhaled Letairis (oral) Non-preferred Preferred
PAH agents, oral and inhaled Revatio tablet (oral) Non-preferred Preferred
PAH agents, oral and inhaled Sildenafil tablet (oral) Preferred Non-preferred
Antiparkinson's agents Dhivy tablet (oral) Non-reviewed Non-preferred
Anticonvulsants Eprontia solution (oral) Preferred Preferred
Growth Hormone Skytrofa cartridge (subcutaneous) Non-reviewed Non-preferred
Immunomodulators, atopic dermatitis Adbry (subcutaneous) Non-reviewed Non-preferred
Ophthalmics, anti-inflammatory/immunomodulator Tyrvaya spray (nasal) Non-reviewed Non-preferred
Ophthalmics, glaucoma agents Vuity (ophthalmic) Non-reviewed Non-preferred