A-2.2. Purpose, Role, and Duties
The purpose of the Board is to advise the Texas Health and Human Services Commission (HHSC) on matters as described below:
- A. Federally required Medicaid Drug Utilization Review Program duties under 42 CFR § 456.703;
- B. Prospective drug utilization review (DUR) in compliance with 42 CFR § 456.716(d)(2) of use of restrictions or clinical prior authorization criteria on covered prescription drugs using recommended predetermined standards to monitor potential drug therapy problems;
- C. Retrospective DUR in compliance with 42 CFR § 456.716(d)(3) to identify standard care provided by health care professions with prescribing authority while allowing permitting sufficient professional prerogatives to allow for individualized drug therapy;
- D. Educational interventions for Medicaid providers to improve prescribing and dispensing practices and effectively improve the quality of drug therapy in compliance with 42 CFR § 456.716(d)(5) and 456.716(d)(6);
- E. Texas Medicaid preferred drug lists by HHSC under Texas Government Code § 531.072, which considers the drugs' efficacy, clinical significance, cost-effectiveness, and safety; and
- F. Other matters may be specified by law and within the Board's jurisdiction.
In addition to performing any other duties set out by federal law, the Board shall:
- A. Develop and submit to HHSC recommendations for preferred drug lists;
- B. Suggest to HHSC restrictions or clinical edits on prescriptions drugs;
- C. Recommend to HHSC educational interventions for Medicaid providers;
- D. Review drug utilization across Medicaid; and
- E. Perform other duties that may be specified by law and otherwise make recommendations to HHSC.
The Board's activities are detailed in an annual report to the Centers for Medicare & Medicaid Services prepared by HHSC Vendor Drug Program staff.