New Medicaid, CHIP Provisional Formulary Begins Nov. 18, 2024

House Bill 3286, 88th Legislature, Regular Session, 2023, required the Texas Health and Human Services Commission Vendor Drug Program (VDP) to create a provisional formulary coverage status allowing VDP to cover drugs on a provisional basis while reviewing the Certificate of Information (COI), the required manufacturer drug application. This change allows drugs to be available to enrollees more quickly.

Beginning Nov. 18, drugs added to the provisional formulary are available for reimbursement at the pharmacy point-of-sale for enrollees in Medicaid managed care, fee-for-service, and the Children’s Health Insurance Program. VDP will make the list of these drugs available on the VDP website. Drugs on the provisional list may become unavailable if VDP denies the COI.

The same prior authorizations will apply to provisional formulary drugs. If the provisional drug is in a class requiring clinical prior authorization or preferred drug list prior authorization, prescribers should call the Texas Pharmacy Prior Authorization Call Center at 877-PA-TEXAS (877-728-3927) or use the VDP Provider Portal to request prior authorization for fee-for-service.

For managed care, contact the MCO’s prior authorization call center. Use the MCO Search to find contact information for each MCO.

No special action is needed by pharmacies regarding this change.