November 18, 2019

The Texas Drug Utilization Review Board met Friday, Oct. 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 Jul. 26, 2019, meeting
  • The PDL drug class review schedule for the Jan. 24 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:

  • Bonjesta/Diclegis (doxylamine/pyridoxine)
    • New criteria
  • Cytokine and CAM Antagonist
    • Addition of Rinvoq (upadacitinib)
  • Diacomit (stiripentol)
    • New criteria
  • Sunosi (solriamfetol)
    • Addition of Sunosi to current Provigil/Nuvigil criteria

Approved as presented:

Approved with recommendations:

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.

Public testimony on the anticonvulsant therapeutic class was provided at this meeting but the board did review the class. HHSC will review the class at a future board meeting.

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

PDL Class Drug Current
Status
Recommended Status
Antiparasitics, Topical      Sklice (topical) Preferred Non-preferred
Hypoglycemics, Insulin and related agents Humulin 500, 70/30, Pen (OTC) Non-preferred       Preferred
Hypoglycemics, Insulin and related agents Humalog Pen, Mix Pen, Junior KwikPen, Cartridge Non-preferred Preferred
Hypoglycemics, Insulin and related agents Novolin Vial Non-preferred       Preferred
Opiate Dependence Treatments Buprenorphine/Naloxone (tablets and film), Lucemyra Non-preferred All agents in this class are Preferred
Antipsychotics Saphris (sublingual) Preferred 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.