November 20, 2017

The Texas Drug Utilization Review Board held their quarterly meeting on November 3, 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 July 28, 2017, meeting
  • A report of this quarter’s clinical prior authorization and PDL recommendations
  • The January 2018 PDL drug class review schedule

Clinical Prior Authorizations

Presented:

Approved as presented:

Approved with recommendations:

  • Cytokine and CAM antagonists:
    • Added drugs: Aracalyst, Kevzara, Otezla, Siliq, Taltz, Tremfya
    • Changed ‘active infection’ to read ‘serious active infection’ throughout the document
    • Otezla, changed ‘severe renal impairment’ to ready ‘chronic kidney disease (stage 4 or 5)’ on the criteria logic and logic diagram
  • Gastrointestinal (GI) motility agents:
    • Added drugs:  Viberzi, Trulance
    • Viberzi, changed lookback for IBS-D to 730 days on criteria logic and logic diagram.
  • Ingrezza (Valbenazine):
    • Added GCN for Ingrezza 80mg capsule, page 2
    • Updated criteria logic and diagram to include dosing for 80mg capsule, pages 3 and 4.

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.