November 8, 2018

The Texas Drug Utilization Review Board met Oct 26 to make recommendations about clinical prior authorizations and drugs to be included on the Texas Medicaid Preferred Drug List. Available online are:

  • A recording of this meeting’s webcast
  • A report of this quarter’s clinical prior authorization and PDL recommendations
  • Approved minutes from the Jul. 27, 2018, meeting
  • The PDL drug class review schedule for January

Clinical Prior Authorization Updates

Clinical prior authorizations may implement for traditional Medicaid and Medicaid managed care at any time. Providers and stakeholders will be notified once an implementation date has been set for traditional Medicaid, and may refer to the MCO Resources for a link to each health plan’s list of active clinical prior authorizations.

Presented:

Approved as presented:

  • NA

Approved with recommendations:

  • CGRP modifications
    • Add step to check for chronic opiate utilization (60 day therapy in last 90 days, if found deny request
    • Step 5: increase migraine prophylactic therapy to 60 days in last 365 days
    • Shorten approval duration from 365 to 90 days

Denied as presented:

  • NA

Tabled for next meeting:

Preferred Drug List Updates

Preferred drugs are medications recommended by the board for their efficaciousness, clinical significance, safety, and cost effectiveness. PDL recommendations are pending until final decisions are released by the HHSC executive commissioner. HHSC-approved decisions from the July and October 2018 board meetings will be incorporated into the next PDL, published in January 2019. Health plans will have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

The Oct. 2018 PDL recommendations are available. Notable changes include:

  • Cytokine and CAM Antagonists class
    • Enbrel recommended non-preferred
  • Opiate Dependence Treatments class:
    • Bunavail (Buccal), Vivitrol (intramusc), Zubsolv (sublingual) recommended preferred
    • Lucemyra (oral) recommended non-preferred

About the Texas DUR Board

Board members meet quarterly in Austin to make recommendations about outpatient prescription drugs in the Medicaid program. The schedule of upcoming meetings, instructions on how to submit written materials to the board, and directions about publicly testifying before the board are available.