May 12, 2017

The Texas Drug Utilization Review (DUR) Board held their quarterly meeting on April 28, 2017, to make recommendations about clinical prior authorizations and drugs to include on the Texas Medicaid Preferred Drug List (PDL). Available online are:

  • A recording of this meeting’s webcast
  • Approved minutes of the January 27, 2017, meeting
  • A report of this quarter’s clinical prior authorization and PDL recommendations
  • The July 2017 PDL drug class review schedule

Clinical Prior Authorizations

Presented

Approved with recommendations

  • Growth Hormone (PDF)
    • Add a quick reference guide to test requirement for prescribing providers
    • Question 4 of Serostim criteria logic changed to ask for two or more claims for single ingredient antiretroviral agents or one claim for a combination ingredient antiretroviral agent in the last 90 days
    • Updated Serostim criteria logic diagram to match change to question 4
    • Updated Table 4, pages 80-83. Table 4a contains single ingredient antiviral agents and Table 4b contains ingredient antiviral agents

Reminder

  • HHS will send notification once an implementation date has been set for traditional Medicaid
  • Managed care organizations have the option to implement any of the board-approved clinical prior authorizations

Preferred Drug List

Reminder

  • PDL recommendations are pending the final decision of the HHS Executive Commissioner
  • HHS-approved decisions from the January and April 2017 board meetings will be incorporated into the July 2017 PDL update.

About the Texas DUR Board

Board members meet quarterly in Austin to make recommendations about the Medicaid program, including developing and submitting recommendations for the Texas PDL, and suggesting clinical prior authorizations on outpatient prescription drugs. The schedule of future meetings and instructions on how to testify and submit written material for consideration are available online.