Formulary

The Texas Drug Code Index includes program-specific formularies for Medicaid, the Children’s Health Insurance Program (CHIP), the Children with Special Health Care Needs (CSHCN) Services Program, the Healthy Texas Women (HTW) Program, and Kidney Health Care (KHC) Program. HHSC requires managed care organizations to adhere to the Medicaid and CHIP formularies.

These formularies include:

• Legend drugs
• Over-the-counter drugs

Refer to the Pharmacy Provider Procedure Manual for more information about other products available as a pharmacy benefit, including:

• COVID-19 vaccines
• COVID-19 test kits
• COVID-19 oral antivirals
• Hepatitis C Treatment Products
• Home health supply products
• Influenza vaccines
• Insulin and insulin syringes
• Long-acting injectables
• Long-acting reversible contraception products
• Mosquito repellents
• Vitamins and minerals

Some drugs are subject to one or both types of prior authorization, clinical and non-preferred.

• All drugs requiring non-preferred prior authorization
• All drugs requiring clinical prior authorization 

Refer to the Pharmacy Provider Procedure Manual for information about drugs with specific processing requirements:

• Biosynthetic growth hormone products
• Cystic fibrosis treatment products
• Emflaza
• Synagis