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 Code of Federal Regulations (CFR) section 456.703;
- B. Prospective drug utilization review (DUR) in compliance with 42 CFR section456.716(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 section 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 section 456.716(d)(5) and 456.716(d)(6);
- E. Texas Medicaid preferred drug lists by HHSC under Texas Government Code section 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 and Medicaid Services prepared by HHSC Vendor Drug Program staff.