Makena Added to Medicaid, CHIP Formulary Starting June 15

Starting June 15, Makena, the brand name version of 17P or hydroxyprogesterone caproate, will be on the Texas Health and Human Services Commission (HHSC) Medicaid and Children's Health Insurance Program formulary. Makena will be available in a 120 mg/5 mL dosage as both a medical and pharmacy benefit. HHSC's Vendor Drug Program implemented Makena as a Medicaid pharmacy benefit in an effort to help reduce preterm births by expanding access to the drug.

Makena and the compounded version of 17P will continue to be available as Medicaid medical benefits. As a pharmacy benefit, Makena will require a clinical prior authorization for fee-for-service. Health plans may elect to require a clinical prior authorization. Contact the health plan for specific requirements. 

The rates and fee schedule will not change at this time. The addition of Makena will be reflected in the daily formulary file on June 10, and health plans are expected to adjudicate claims with this drug by June 15. 

For additional information and health plan guidance, visit the Vendor Drug Program website.

For additional information about the medical benefit, visit the Texas Medicaid & Healthcare Partnership (TMHP) website, or call the TMHP Contact Center at (800) 925-9126

HHSC says physicians should encourage patients to use Lumara Health's My Adherence Program, designed to facilitate improved patient compliance with Makena therapy. Each expecting mother who has been prescribed Makena and enrolls (at no additional cost) in My Adherence Program will be paired with a dedicated maternal health nursing specialist who will encourage adherence to the weekly Makena injections, identify barriers, and potentially provide solutions to overcome any problems that may arise during treatment. Call (844) 660-0867 for more information about the My Adherence Program.

Action, June 1, 2015

Last Updated On

May 13, 2016