November 4, 2020

The Texas Drug Utilization Review Board met Thursday, Oct. 22 and Friday, Oct. 23 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 July 24, 2020, meeting
  • The PDL drug class review schedule for the Jan. 22, 2021, 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:

Approved with recommendations:

  • Calcitonin gene-related peptide receptor (CRGP) antagonists, acute Nurtec/Ubrelvy (PDF)
    • Add ‘client has been to the emergency room for migraine or has had imaging tests for migraine’ to the prescribed by, or in consultation with, a specialist step
    • Add ‘or client has a contraindication to triptans’ to the step asking for a trial of 2 different triptans
    • Remove the 180 day look back to the step asking for a trial of 2 different triptans
  • Oriahnn (capsules) (PDF)
    • Remove claim for an NSAID on prior therapy step
    • Change ‘oral contraceptive’ to ‘contraceptive agent’ on the prior therapy step
    • Update criteria guide to indicate step checking for uncontrolled hypertension is a manual step
  • Wakix (tablets) (PDF)
    • Add diagnosis of cataplexy with no prior therapy requirements
    • Add ‘client has had a sleep study with sleep latency’ to the prescribed by, or in consultation with, a specialist step
  • Xywav (oral solution) (PDF)
    • Add ‘client has had a sleep study with sleep latency’ to the prescribed by, or in consultation with, a specialist step

Tabled:

  • Evrysdi (oral solution)

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 Jul. 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 Oct. 2020 PDL recommendations are available. Notable changes include:

Preferred Class Drug Current Status Recommended Status
Anticonvulsants All Drugs No Status Preferred
Hemophilia Treatment All Drugs No Status Preferred
HIV/AIDS All Drugs No Status Preferred
Multiple Sclerosis Agents All Drugs No Status Preferred
Oncology, oral - Breast All Drugs No Status Preferred
Oncology, oral - Hematologic All Drugs No Status Preferred
Oncology, oral - Lung All Drugs No Status Preferred
Oncology, oral - Other All Drugs No Status Preferred
Oncology, oral - Prostate All Drugs No Status Preferred
Oncology, oral – Renal Cell All Drugs No Status Preferred
Oncology, oral - skin All Drugs No Status Preferred
Antiparasitics, topical Vanalice Gel, OTC Non-Preferred Preferred
Antipsychotics Caplyta (oral) No Status Non-Preferred
Antipsychotics Fluphenazine Decanoate (injection) No Status Non-Preferred
Antipsychotics Haldol Decanoate (intrmusc) No Status Non-Preferred
Antipsychotics Haloperidol Decanoate (injection) No Status Preferred
Antipsychotics Geodon (intramusc) No Status Non-Preferred
Antipsychotics Haloperidol Lactate (injection) No Status Non-Preferred
Antipsychotics Olanzapine (intramusc) No Status Non-Preferred
Antipsychotics Zypreza (intramusc) No Status Non-Preferred
Colonly Stimluting Factors Fulphila (subcutaneous) Preferred Non-Preferred
Colony Stimlulating Factors Granix Syringe (injection) Preferred Non-Preferred
Gastrointestinal Motility, chronic Amitiza (oral) Non-Preferred Preferred
Hepatitis C Agents Harvoni Pellect Pack (oral) No Status Non-Preferred
Hepatitis C Agents Sovaldi Pellet Pack (oral) No Status Non-Preferred
Macrolides-Ketolides Eryped 200 Suspension (oral) Non-Preferred Preferred
Macrolides-Ketolides Eryped 400 Suspension (oral) 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 online.

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DUR Board