190.026D Medicaid Preferred Drug List

190.026D

Medicaid Preferred Drug List: The Texas Medical Association will pursue changes in the Medicaid PDL so that children can readily obtain medications. Such changes include, but are not limited to, the following:

Change policy on premium preferred generics (PPG) so that the PPG medications do not require prior approval when the pharmacy chooses a non-PPG manufacturer.

Eliminate prior approval requirement for drugs that are the only drugs in their class for a specific age group. For example, with nebulized budesonide respules, or Pulmicort, the date of birth can be matched with the medication, and an automatic approval can be generated.

Include all forms of a drug in the same PDL category (i.e., if a drug is preferred, then all forms of the drug are preferred - liquid, tablet, capsule, redi-tab, all strengths, and all combinations are included).

List drugs in multiple, searchable, downloadable formats (e.g., alphabetical and by drug class).

Allow exceptions to the rebate requirement in special, carefully defined circumstances.

Allow other modalities for prior approval, including but not limited to, electronic or fax (Amended CM-CAH Rep. 1-A-08; deleted CSE Rep. 1-A-18).

Last Updated On

August 20, 2018