Effective January 27, 2022: Texas Medicaid Preferred Drug List Updates
Date: 01/13/22
The Texas Health and Human Services (HHS) will publish the semi-annual update of the Texas Medicaid Preferred Drug List (PDL) on Thursday January 27th, 2022. The update will be based on changes presented at the Vendor Drug Program (VDP) Drug Utilization Review (DUR) Board meetings in July and November 2021. Superior HealthPlan follows the Texas Medicaid Vendor Drug Formulary and the PDL.
The tables below summarizes some of the anticipated noteworthy changes from the July 2021 and November 2021 DUR meetings.
Please note: The tables are not the complete list of changes. Please reference the Texas Medicaid PDL for a complete list of recommended medications or visit DUR Board webpage on the Texas Vendor Drug website for all decisions.
Notable changes from July 2021 DUR board meeting:
PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
Immunosuppressives, oral | Rapamune tablet (oral) | Non-preferred | Preferred |
Immunosuppressives, oral | Sirolimus tablet (Authorized Generic [AG]) (oral) | Preferred | Non-preferred |
Immunosuppressives, oral | Sirolimus tablet (oral) | Preferred | Non-preferred |
Ophthalmics, anti-inflammatories | Lotemax drops (ophthalmic) | Non-preferred | Preferred |
Ophthlamics, anti-inflammatory/immunomodulators | Xiidra (ophthalmic) | Non-preferred | Preferred |
Platelet Aggregation Inhibitors | Aggrenox (oral) | Preferred | Non-preferred |
Platelet Aggregation Inhibitors | Aspirin/Dipyridamole (oral) | Non-preferred | Preferred |
Stimulants and related Agents | Qelbree (oral) | Non-reviewed | Preferred |
Notable changes from November 2021 PDL DUR meeting:
PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
Anticonvulsants | Elepsia XR tablet (oral) | Non-reviewed | Preferred |
Anticonvulsants | Rufinamide suspension (oral) | Non-reviewed | Preferred |
Anticonvulsants | Rufinamide tablet (oral) | Non-reviewed | Preferred |
Antipsychotics | Perseris (subcutaneous) | Non-preferred | Preferred |
Antipsychotics | Vraylar (oral) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Aspart cartridge (AG) (subcutaneous) | Preferred | Non-preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Aspart pen (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Aspart vial (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Aspart/Insulin Aspart Protamine insulin pen (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Aspart/Insulin Aspart Protamine vial (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Lispro Junior Kwikpen (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Lispro pen (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Lispro Protamine Mix Kwikpen (AG) (subcutaneous) | Non-preferred | Preferred |
Hypoglycemics, Insulin, and Related Agents | Insulin Lispro vial (AG) (subcutaneous) | Non-preferred | Preferred |
Opiate Dependence Treatments | Kloxxado spray (nasal) | Non-reviewed | Preferred |
Glucagon Agents | Zegalogue autoinjector (subcutaneous) | Non-reviewed | Non-preferred |
Glucagon Agents | Zegalogue syringe (subcutaneous) | Non-reviewed | Non-preferred |
Immunosuppressives | Benlysta autoinjector (subcutaneous) | Non-reviewed | Non-preferred |
Immunosuppressives | Benlysta Syringe (subcutaneous) | Non-reviewed | Non-preferred |
Immunosuppressives | Lupkynis (oral) | Non-reviewed | Non-preferred |
Oncology, Oral - Lung | Lumakras (oral) | Non-reviewed | Preferred |
Oncology, Oral - Other | Truseltiq (oral) | Non-reviewed | Preferred |
HHS designates drugs on the Texas Medicaid formulary as preferred, non-preferred or have neither designation. The PDL includes only drugs identified as either preferred or non-preferred:
- Drugs not on the PDL, 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.
- HHS will publish the preferred drug list will be posted by January 24, 2022 to reflect the recent changes.
The PDL Criteria Guide (PDF) outlines the criteria used to evaluate the non-preferred prior authorization requests. HHS will update the guide by January 24, 2022 to reflect the recent changes.