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New regulations restrict opioid cough and cold prescriptions

Effective April 2, opioid cough and cold medications will not be covered by Texas Medicaid fee-for-service for individuals 17 years and younger. The new restriction is based on the U.S. Food and Drug Administration’s recent decision to require safety labeling that limits the use of prescription cough cold medication containing codeine or hydrocodone to individuals 18 years and older.

Consult the Health and Human Services Vendor Drug Program for more information and a list of drugs on the Medicaid formulary that are affected by the change. Physicians and pharmacists should consult a patient’s Medicaid managed care organization for claim limitation requirements.