May 10, 2019

The Texas Drug Utilization Review Board met Friday, Apr. 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 Jan. 25, 2019, meeting
  • The PDL drug class review schedule for the Jul. 26 meeting

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.
  • Refer to MCO Resources for a link to each MCO's list of active clinical prior authorizations.
  • The Pharmacy Clinical Prior Authorization Assistance Chart (PDF) identifies which prior authorizations are utilized by each MCO and how those relate to those used by the Vendor Drug Program.

Presented:

Approved as presented:

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 the final decision is released by the HHSC executive commissioner. HHSC-approved decisions from the Jan. and Apr. 2019 board meetings will be incorporated into the PDL published in Jul. 2019. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

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

PDL Class Drug Current Status Recommended Status
Antivirals, oral Rimantadine (oral) Preferred Non-preferred
Antivirals, oral Tamiflu Suspension (Oral) Preferred Non-preferred
Antivirals, oral Xofluza (Oral) No status Non-preferred
Bronchodilators, beta agonist Proventil HFA (inhalation) Non-preferred Preferred
Cytokine and cam antagonists Actemra pen (subcutaneous) No status Non-preferred
Cytokine and cam antagonists Cosentyx Pen Injecter (Subcutane.) Non-preferred Preferred
Cytokine and cam antagonists Cosentyx Syringe (Subcutane.) Non-preferred Preferred
Cytokine and cam antagonists Ilumya Syringe (Subcutaneous) No status Non-preferred
Cytokine and cam antagonists Kevzara Pen (Subcutaneous) No status Non-preferred
Cytokine and cam antagonists Olumiant (Oral) No status Non-preferred
Cytokine and cam antagonists Otezla (Oral) Non-preferred 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.