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:
- Acthar - revision (PDF)
- Oxervate - new criteria (PDF)
- Palforzia - new criteria (PDF)
- Spravato - new criteria (PDF)
Approved as presented:
- HP Acthar (PDF) (Pending Implementation) (Revised July 24, 2020)
- Oxervate (PDF) (Pending Implementation) (Revised July 24, 2020)
- Palforzia (PDF) (Pending Implementation) (Revised July 24, 2020)*
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