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January 2022 Preferred Drug List Now Available

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The January 2022 Medicaid Preferred Drug List (PDL) is available. This update includes changes approved at the July and November 2021 Drug Utilization Review Board meetings. The document includes formulary and prior authorization information, notations for drugs requiring clinical prior authorization, the review schedule, and appendices for cough and cold products, iron oral agents, and prenatal vitamin products.

Preferred Drug Reminders

  • Prescribing providers must use the Texas Medicaid Formulary and the PDL. Providers who prescribe medications for clients enrolled in the Children’s Health Insurance Program (CHIP) must use the CHIP Formulary. CHIP does not have a PDL.
  • The PDL does not include every drug on the Texas Medicaid Formulary.
  • Drugs on the Texas Medicaid Formulary are designated as “preferred,” “non-preferred,” or neither. The PDL includes only drugs identified as either “preferred” or “non-preferred,” which are described below:
    • Drugs that are not on the preferred list and drugs that are identified on the list as “preferred” are available without prior authorization.
    • Drugs on the PDL that are identified as “non-preferred” will require prior authorization.
    • Some “preferred” and “non-preferred” drugs might require clinical prior authorization.
    • Some drugs on the formulary and the PDL are subject to one or both types of prior authorization: “clinical” or “non-preferred.”
    • Prescribing providers must obtain prior authorizations. Pharmacy staff may not request prior authorizations.

The Preferred Drug List Criteria Guide outlines the criteria used to evaluate the “non-preferred” prior authorization requests. The Texas Health and Human Services Commission (HHSC) will update the guide to reflect the recent changes by January 24, 2022.

Obtaining Medicaid Outpatient Drug Prior Authorization

Prescribing providers must obtain prior authorization for outpatient drugs based on Medicaid guidelines in the following ways:

  • For clients enrolled in a Medicaid managed care organization (MCO), prescribing providers or their representatives should contact the MCO’s prior authorization call center. Prior authorization call center phone numbers vary by MCO. A list of prior authorization call centers is available in the MCO Resource Information. The chart is available to download from com/resources/downloads under the “Managed care documents” heading.
  • For clients in traditional Medicaid, prescribing providers or their representatives should call the Texas Prior Authorization Call Center at 877-PA-TEXAS (877-728-3927).

Online Drug Reference Information

The following information is available online:

  • The Medicaid and CHIP formularies and the Medicaid PDL are available online. Formulary information for all state health programs administered by HHSC is also available online.
  • Epocrates is a free subscription drug information service that can be downloaded to a computer or handheld device. In addition to listing a drug’s preferred status, Epocrates includes drug monographs, dosing information, and warnings. All prescribing providers are eligible to register for Epocrates online. Refer to the Outpatient Drug Services Handbook in the Texas Medicaid Provider Procedure Manual to learn more.

Prescribers may use their e-prescribing software to view the Medicaid and CHIP formularies or find “preferred” drugs and alternatives to “non-preferred” medications.

72-Hour Emergency Supply

The prescribing provider is responsible for obtaining prior authorization. The pharmacy staff alerts the prescribing provider to obtain prior authorization if approval was not obtained when the prescription was presented to the pharmacy. If medication is needed without delay, the pharmacy staff can provide a 72-hour emergency supply of the medication while the prescribing provider obtains the authorization. Dispensing an emergency supply offers the client an immediate dose of the medicine but requires a return trip to the pharmacy for the entire prescription or alternate therapy. Refer to section 12.5 of the Outpatient Drug Services Handbook in the Texas Medicaid Provider Procedure Manual to learn more.

Pharmacy Prior Authorization Quick Course

Providers who need a quick refresher on Medicaid pharmacy benefits and prior authorization can refer to A Prescriber’s Guide to Texas Medicaid Outpatient Pharmacy Prior Authorization.

Email vdp-formulary@hhsc.state.tx.us with comments or questions.