August 11, 2020

The Texas Drug Utilization Review Board met Friday, July 24 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 May 22, 2020, meeting
  • The PDL drug class review schedule for the Oct. 23 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:

Tabled for next meeting:

  • Spravato

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 July and Oct. 2020 board meetings will be incorporated into the PDL published in Jan. 2021. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

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

Preferred Class Drug Current Status Recommended Status
Alzeimer’s Agents Exelon (Transderm.) Non-Preferred Preferred
Alzeimer’s Agents Rivastigmine (Ag) (Transderm.) Preferred Non-Preferred
Alzeimer’s Agents Rivastigmine (Transderm.) Preferred Non-Preferred
Antimigraine Agents Ajovy Autoinjector (Subcutaneous) No Status Non-Preferred
Antimigraine Agents Ubrelvy (Oral) Non-Preferred Preferred
Cephalosporins and Related Antibiotics Amoxicillin/Clav Xr (Oral) Preferred Non-Preferred
Non-Steroidal Anti-Inflammatory Drugs Diclofenac Gel (Topical) Non-Preferred Preferred
Non-Steroidal Anti-Inflammatory Drugs Diclofenac Potassium (Oral) Non-Preferred Preferred
Non-Steroidal Anti-Inflammatory Drugs Naproxen Ec (Oral) Non-Preferred Preferred
Otic Antibiotics Ciprofloxacin (Otic) Preferred Non-Preferred
Otic Antibiotics Ofloxacin (Otic) Non-Preferred Preferred
Rosacea Agents, Topical Azelaic Acid (Ag) (Topical) No Status Non-Preferred
Rosacea Agents, Topical Azelaic Acid (Topical) No Status Non-Preferred
Rosacea Agents, Topical Finacea (Topical) No Status Non-Preferred
Rosacea Agents, Topical Finacea Foam (Topical) No Status Non-Preferred
Rosacea Agents, Topical Ivermectin (Ag) (Topical) No Status Non-Preferred
Rosacea Agents, Topical Ivermectin (Topical) No Status Non-Preferred
Rosacea Agents, Topical Metrocream (Topical) No Status Non-Preferred
Rosacea Agents, Topical Metrogel (Topical) No Status Non-Preferred
Rosacea Agents, Topical Metronidazole Cream (Topical) No Status Preferred
Rosacea Agents, Topical Metronidazole Gel (Ag) (Topical) No Status Preferred
Rosacea Agents, Topical Metronidazole Gel (Topical) No Status Preferred
Rosacea Agents, Topical Metronidazole Lotion (Topical) No Status Non-Preferred
Rosacea Agents, Topical Mirvaso (Topical) No Status Non-Preferred
Rosacea Agents, Topical Noritate (Topical) No Status Non-Preferred
Rosacea Agents, Topical Rhofade (Topical) No Status Non-Preferred
Rosacea Agents, Topical Rosadan Kit (Topical) No Status Non-Preferred
Rosacea Agents, Topical Soolantra (Topical) No Status Non-Preferred
Anti-Allergens, Oral Palforzia Maintenance Sachet (Oral) No Status Non-Preferred
Anti-Allergens, Oral Palforzia Titration Capsule (Oral) No Status Non-Preferred
Antipsychotics Caplyta (Oral) No Status Non-Preferred
Hypoglycemics, Incretin Mimetics/Enhancers Trijardy Xr (Oral) No Status Preferred
Hypoglycemics, Metformins Riomet Er Suspension (Oral) No Status Non-Preferred
Immune Globulins Hizentra Syringe (Subcutaneous) No Status Non-Preferred
Lipotropics, Other Nexletol (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
DUR Board
PDL