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:
-
Cytokine and CAM Antagonist (PDF)
- Addition of Skyrizi
-
GI Motility (PDF)
- Addition of Motegrity
-
Skeletal Muscle Relaxants (PDF)
- Update
Approved as presented:
-
Cytokine and CAM Antagonist (PDF)
- Addition of Skyrizi
-
GI Motility (PDF)
- Addition of Motegrity
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.