February 8, 2019

The Texas Drug Utilization Review Board met Jan. 25, 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 Oct. 26, 2018, meeting
  • The PDL drug class review schedule for April

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:

  • Cytokine and CAM antagonists - addition of Olumiant criteria
  • Epidiolex - new criteria
  • Orilissa - new criteria

Approved as presented:

Approved with recommendations:

Tabled for next meeting:

  • None

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 January and April 2019 board meetings will be incorporated into the next PDL, published in July 2019. Health plans will have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

The Jan. 2019 PDL recommendations are available. Notable changes include:

  • Angiotension Modulators class:
    • Qbrelis solution (oral) remains non-preferred Clients ages 6-12 years will not require PDL authorization
  • Movement Disorder class:
    • Austedo (oral) recommended preferred
    • Xenazine (oral) recommended non-preferred
  • Proton Pump Inhibitors class:
    • Nexium (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.