June 4, 2020

The Texas Drug Utilization Review Board met Friday, May 22 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. 24, 2020, meeting
  • The PDL drug class review schedule for the July 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:

Approved as presented:

  • Monoclonal antibody agents for asthma
  • Transthyretin agents - new criteria

Approved with recommendations:

  • Ophthalmic immunomodulators

Tabled

  • Tricyclic antidepressants
    • tabled for further input from MCOs

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 Texas HHS executive commissioner. HHS-approved decisions from the Jan. and May. 2020 board meetings will be incorporated into the PDL published in July 2020. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

The May 2020 PDL recommendations are available. Notable changes include:

PDL Class Drug Current Status Recommended Status
Antiparkinson’s Agents
  • Bromocriptine (oral)
Preferred Non-Preferred
Glucagon Agents
  • Baqsimi (nasal)
  • Glucagon (injection)
  • Glucagon Emergency Kit (Lilly) (injection)
  • Proglycem Suspension (oral)    
No Status Preferred
Glucagon Agents
  • Glucagon Emergency Kit (Fresenius) (injection)
  • Gvoke Syringe (subcutaneous)
  • Gvoke Pen (subcutaneous)
No Status Non-Preferred
Immunomodulators, Asthma
  • Nucala Auto-injector (subcutaneous)
  • Nucala Syringe (subcutaneous)
No Status Non-Preferred
Immunomodulators, Asthma
  • Fasenra Pen (subcutaneous)
No Status Preferred
Sickle Cell Anemia Treatments
  • Droxia (oral)
  • Hydroxyurea (oral)
No Status Preferred
Sickle Cell Anemia Treatments
  • Endari (oral)
  • Oxbryta (oral)
  • Siklos (oral)
No Status Non-Preferred
Antimigraine agents, other
  • Reyvow (oral)
  • Ubrelvy (oral)
No Status 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.

Tags: 
Clinical PA
Drug
PDL