August 11, 2017

The Texas Drug Utilization Review Board held their quarterly meeting on July 28 to make recommendations about clinical prior authorizations and drugs to include on the Texas Medicaid Preferred Drug List . Available online are:

  • A recording of this meeting’s webcast
  • Approved minutes of the April 28, 2017, meeting
  • A report of this quarter’s clinical prior authorization and PDL recommendations
  • The November 2017 PDL drug class review schedule

Clinical Prior Authorizations

Presented:

Approved as presented:

  • Nuplazid (pimavanserin): 

Approved with recommendations:

  • Diclofenac 3% Gel, Diclofenac 1.5% and 2% Topical Solution:
    • For the 3% gel, the Board approved this criteria proposal with the following revisions.
      • Extend the look back for diagnosis and any prior therapies to two years.
      • Include a step between steps 2 and 3 to deny in patients with history of gastrointestinal bleed in the last two years.  
    • For the 1.5% and the 2% Topical Solutions the Board approved with the following revision
      • Include a step to deny in patients with history of gastrointestinal bleed in the last two years.
  • Dupixent (dupilumab):
    • Extend the look back for treatment for prior topical corticosteroid and a topical calcineurin inhibitor to 1 year instead of six months.
    • Implement step 2 as presented with monitoring for call volume and physician feedback to consider changing to check for just diagnosis of atopic dermatitis.
  • Emflaza (deflazacort): 
    • Allow the prior authorization criteria to be submitted via a request form (i.e. paper) or as an automated prior authorization.

Reminder:

  • HHS will notify providers and stakeholders once an implementation date has been set for traditional Medicaid.
  • Medicaid managed care organizations (MCO) have the option to implement any board-approved clinical prior authorization at any time.

Preferred Drug List

Preferred drugs are medications recommended by the board for their efficaciousness, clinical significance, safety, and cost effectiveness.

Reminder:

  • PDL recommendations are pending the final decision of the HHS executive commissioner.  HHS-approved decisions from the July and November 2017 board meetings will be incorporated into the January 2018 PDL update.
  • Prescribing providers must adhere to the Medicaid formulary and PDL.
  • MCOs must adhere to the PDL.

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.