Community First Health Plans is sharing information regarding updates to the Healthy Texas Women (HTW) program pharmacy benefit that became effective July 1, 2026.
HTW provides women’s health and family planning services to eligible women, while HTW Plus offers enhanced postpartum services for women who have been pregnant within the previous 12 months. HTW Plus services focus on conditions that contribute to maternal morbidity and mortality, including postpartum depression, cardiovascular conditions, and substance use disorders.
Program Updates
Effective July 1, 2026, the list of covered drugs available to HTW members expanded to include all Medicaid‑eligible drugs within health care categories covered by the HTW program.
In addition, the Texas Health and Human Services Commission (HHSC) has aligned HTW pharmacy coverage with Texas Medicaid by applying:
- The Texas Medicaid Preferred Drug List (PDL)
- Applicable clinical prior authorization requirements
- Existing Medicaid formulary requirements for covered drugs
These changes support HHSC’s transition of HTW from a state-funded program to a Medicaid-funded program and help promote consistency across Medicaid programs.
Provider Considerations
Providers are encouraged to review the updated PDL and applicable prior authorization requirements when prescribing medications for Healthy Texas Women members. Changes to formulary status may affect coverage and authorization requirements for certain drugs.
Resources
- Healthy Texas Women Program
- TMHP Healthy Texas Women Information
- Texas Medicaid Preferred Drug List (PDL)
- PDL Criteria Guide
For questions regarding pharmacy benefits or prior authorization requirements, contact the Texas Medicaid Pharmacy and Technical Call Center at 800-435-4165, Monday through Friday, 7 a.m. to 7 p.m. Central Time.
Action:
Providers are encouraged to share this information with their staff. If you have any questions about this notice, please email Provider Relations at ProviderRelations@cfhp.com or call 210-358-6030. You can also contact your Provider Relations Representative directly.
To access all Provider alerts:
- Log into the Community First Provider Portal
- Go to CommunityFirstHealthPlans.com/Provider-News
- Sign up for the Community First Provider eNewsletter