Texas Medicaid will perform the semi-annual update of the Medicaid preferred drug list on July 27. HHSC made the PDL changes based on recommendations made at the January and April 2023 Texas Drug Utilization Review Board meetings. Drug list decisions from those 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 (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 January PDL decisions.
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Antimigraine Agents, other | Ubrelvy (oral) | Non-preferred | Preferred |
| Bladder Relaxant Preparations | Myrbetriq (oral) | Non-preferred | Preferred |
| Bladder Relaxant Preparations | Myrbetriq granules (oral) | Non-preferred | Preferred |
| Glucagon Agents | Gvoke pen (subcutaneous) | Non-preferred | Preferred |
| Glucagon Agents | Gvoke syringe (subcutaneous) | Preferred | Non-preferred |
| Intranasal Rhinitis Agents | Ryaltris (nasal) | Not reviewed | Non-preferred |
| Movement Disorders | Tetrabenazine (oral) | Preferred | Non-preferred |
| Movement Disorders | Xenazine (oral) | Non-preferred | Preferred |
| Pulmonary Arterial Hypertension Agents, oral and inhaled | Tadliq suspension (oral) | Not reviewed | Non-preferred |
| Stimulants and Related Agents | Dyanavel XR tablet (oral) | Not reviewed | Non-preferred |
| Stimulants and Related Agents | Quillichew ER (oral) | Preferred | Non-preferred |
| Stimulants and Related Agents | Xelstrym (transdermal) | Not reviewed | Non-preferred |
| Anticonvulsants | Zonisade (oral) | Not reviewed | Preferred |
| Anticonvulsants | Ztalmy (oral) | Not reviewed | Preferred |
| Antidepressants, other | Auvelity (oral) | Not reviewed | Non-preferred |
| Benign Prostatic Hyperplasia Treatments | Entadfi (oral) | Not reviewed | Non-preferred |
| Colony Stimulating Factor | Fylnetra (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cam Antagonists | Skyrizi on-body (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cam Antagonists | Sotyktu (oral) | Not reviewed | Non-preferred |
| Multiple Sclerosis Agents | Tascenso ODT (oral) | Not reviewed | Preferred |
| Urea Cycle Disorders, oral | Pheburane (oral) | Not reviewed | Non-preferred |
The second table includes the January PDL from the April PDL recommendations.
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Anti-Allergens, Oral | Oralair (sublingual) | Non-preferred | Preferred |
| Anti-Allergens, Oral | Palforzia titration capsule (oral) | Non-preferred | Preferred |
| Anticoagulants | Pradaxa pellet pack (oral) | Not reviewed | Non-preferred |
| Anticoagulants | Xarelto suspension (oral) | Non-preferred | Preferred |
| Antidepressants, other | Venlafaxine Besylate ER (oral) | Not reviewed | Non-preferred |
| Antidepressants, other | Viibryd (oral) | Non-preferred | Preferred |
| Antivirals, oral | Valcyte tablet (oral) | Non-preferred | Preferred |
| Antivirals, oral | Valganciclovir tablet (oral) | Preferred | Non-preferred |
| Bronchodilators, beta agonist | Serevent (inhalation) | Non-preferred | Preferred |
| Bronchodilators, beta agonist | Xopenex HFA (inhalation) | Non-preferred | Preferred |
| Bronchodilators, beta agonist | Xopenex neb soln (inhalation) | Non-preferred | Preferred |
| Cough and Cold, non-narcotic | Duraflu tablet OTC (oral) | Non-preferred | Preferred |
| Cough and Cold, non-narcotic | Polytussin DM OTC (Oral) | Non-preferred | Preferred |
| Cough and Cold, non-narcotic | Vanacof DMX Liquid OTC (oral) | Non-preferred | Preferred |
| Cytokine and CAM Antagonists | Amjevita autoinjector HC (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and CAM Antagonists | Amjevita autoinjector LC (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and CAM Antagonists | Amjevita syringe (subcutaneous) | Not reviewed | Non-preferred |
| Hemophilia Treatment | Hemgenix (intraven) | Not reviewed | Preferred |
| Immunomodulators, Asthma | Tezspire pen (subcutaneous) | Not reviewed | Non-preferred |
| Immunomodulators, Atopic Dermatitis | Protopic (topical) | Preferred | Non-preferred |
| Immunomodulators, Atopic Dermatitis | Tacrolimus (AG) (topical) | Non-preferred | Preferred |
| Immunomodulators, Atopic Dermatitis | Tacrolimus (topical) | Non-preferred | Preferred |
| Lipotropics, other | Praluent pen (subcutaneous) | Non-preferred | Preferred |
| Lipotropics, other | Repatha pushtronex (subcutaneous) | Non-preferred | Preferred |
| Lipotropics, other | Repatha sureclick (subcutaneous) | Non-preferred | Preferred |
| Lipotropics, other | Repatha syringe (subcutaneous) | Non-preferred | Preferred |
| Lipotropics, other | Vascepa (oral) | Non-preferred | Preferred |
| Pediatric Vitamin Preparations | Pedi Mvi No.17 with fluoride chew (oral) | Non-preferred | Preferred |
| Pediatric Vitamin Preparations | PNV NO.15/IRON FUM & PS CMP/FA (Oral) | Non-preferred | Preferred |
| Pediatric Vitamin Preparations | Prenatal Vit #76/Iron,Carb/FA (Oral) | Non-preferred | Preferred |
| Pediatric Vitamin Preparations | Prenate Enhance (Oral) | Non-preferred | Preferred |
| Thrombopoiesis Stimulating Proteins | Promacta suspension (oral) Age Exception: 12 years and under |
Non-preferred | Non-preferred |
| Urea Cycle Disorders, Oral | Carbaglu (oral) | Non-preferred | Preferred |
| Urea Cycle Disorders, Oral | Pheburane (oral) | Non-preferred | Preferred |
| Antifungals, oral | Noxafil suspdr pkt (oral) | Not reviewed | Non-preferred |
| Colony Stimulating Factors | Rolvedon syringe (subcutaneous) | Not reviewed | Non-preferred |
| Colony Stimulating Factors | Stimufend syringe (subcutaneous) | Not reviewed | Non-preferred |
| HIV/AIDS | Sunlenca tablet (oral) | Not reviewed | Preferred |
| Hypoglycemics, insulin and related agents | Basaglar tempo pen (subcutane.) | Not reviewed | Non-preferred |
| Hypoglycemics, insulin and related agents | Humalog tempo pen (subcutane.) | Not reviewed | Non-preferred |
| Hypoglycemics, insulin and related agents | Lyumjev tempo pen (subcutane.) | Not reviewed | Non-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 by July 25 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 24 to reflect the recent changes.