August 13, 2019

The Texas Drug Utilization Review Board met Friday, July 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 April 26, 2019, meeting
  • The PDL drug class review schedule for the Oct. 25 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:

Not approved as presented:

  • Skeletal Muscle Relaxants

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 July and Oct. 2019 board meetings will be incorporated into the PDL published in Jan. 2020. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

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

PDL Class Drug Current
Status
Recommended Status
Antiparkinson’s Agents Inbrija (inhalation) No status Non-preferred
Cephalosporins and Related Antibiotics Ceprozil tablet (oral) Non-preferred Preferred
Colony Stimulating Factors Nivestym vial (injection) No status Non-preferred
Cytokine and CAM Antagonist Skyrizi (subcutaneous) No status Non-preferred
Cytokine and CAM Antagonist Tremfya Autoinjector (subcutaneous) No status Non-preferred
GI Motility, Chronic Motegrity (oral) No status Non-preferred
Ophthalmic Antibiotics Ofloxacin (ophthalmic) Non-preferred Preferred
Ophthalmic, Glaucoma Agents Rocklatan (ophthalmic) No status Preferred
Progestational Agents Hydroxyprogesterone Caproate (intramuscular) No status Non-preferred
Ulcerative Colitis Agents Canasa (rectal) Preferred Non-preferred
Ulcerative Colitis Agents Lialda (oral) Preferred Non-preferred
Ulcerative Colitis Agents Mesalamine (Canasa) (rectal) 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.