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.
| 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 |
| 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 |