February 2, 2021
The Texas Drug Utilization Review Board met Friday, Jan. 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 Oct. 22 and 23, 2020, meetings
- The PDL drug class review schedule for the April 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:
- Apokyn and Kynmobi (dopamine agonists) (PDF)
- New criteria
- Evrysdi (oral solution) (PDF)
- New criteria
- Govovri and Osmolex (Amantadine extended-release agents) (PDF)
- New criteria
- Hemady (Dexamethsone) (PDF)
- New criteria
Approved as presented:
- Apokyn and Kynmobi (dopamine agonists)
- Evrysdi (oral solution)
Approved with recommendations:
- Gocovri and Osmolex (Amantadine extended-release agents) (PDF)
- New criteria
- Clarified question 6 on criteria logic diagram: Currently taking levodopa therapy defined as at least 60 days therapy in the last 90 days
- New criteria
- Hemady (Dexamethsone) (PDF)
- New criteria
- Clarified question 4 on criteria logic diagram: Current diagnosis of serious systemic fungal infection defined as diagnosis found in the last 60 days.
- New criteria
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 April 2021 board meetings will be incorporated into the PDL published in July 2021. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The Jan. 2021 PDL recommendations are available. Notable changes include:
| Preferred Drug Class | Drug Name | Current Status | Recommended Status |
|---|---|---|---|
| Angiotensin Modulators | Epaned Solution (Oral) | Non-Preferred | Preferred |
| Antimigraine Agents, Triptans | Imitrex (Nasal) | Non-Preferred | Preferred |
| Antimigraine Agents, Triptans | Sumatriptan Kit (Sun) (Subcutane.) | Non-Preferred | Preferred |
| Antiparkinson’s Agents | Apokyn (Subcutaneous) | Not Reviewed | Non-Preferred |
| Antiparkinson’s Agents | Kynmobi (Sublingual) | Not Reviewed | Non-Preferred |
| Antiparkinson’s Agents | Ongentys (Oral) | Not Reviewed | Non-Preferred |
| H. Pylori Treatment | Talicia (Oral) | Not Reviewed | Non-Preferred |
| Movement Disorders | Tetrabenazine (Oral) | Non-Preferred | Preferred |
| Oncology, Oral – Breast | All Drugs | Preferred | Preferred |
| Oncology, Oral – Hematologic | All Drugs | Preferred | Preferred |
| Oncology, Oral – Lung | All Drugs | Preferred | Preferred |
| Oncology, Oral – Other | All Drugs | Preferred | Preferred |
| Oncology, Oral – Prostate | All Drugs | Preferred | Preferred |
| Oncology, Oral – Renal Cell | All Drugs | Preferred | Preferred |
| Oncology, Oral – Skin | All Drugs | Preferred | Preferred |
| Stimulants and Related Agents | Adderall XR (Oral) | Non-Preferred | Preferred |
| Stimulants and Related Agents | Amphetamine Salt Combo EE (Ag) (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Amphetamine Salt Combo ER (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Aptensio XR (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Concerta (Oral) | Non-Preferred | Preferred |
| Stimulants and Related Agents | Dexmethylphenidate ER (Ag) (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Dexmethylphenidate ER (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Focalin XR (Oral) | Non-Preferred | Preferred |
| Stimulants and Related Agents | Jornay PM (Oral) | Non-Preferred | Preferred |
| Stimulants and Related Agents | Methylphenidate ER (Concerta) (Ag) (Oral) | Preferred | Non-Preferred |
| Stimulants and Related Agents | Wakix (Oral) | Not Reviewed | Non-Preferred |
| Cytokine and Cam Antagonists | Enbrel Vial (Subcutaneous) | Not Reviewed | Preferred |
| Cytokine and Cam Antagonists | Enspryng (Subcutaneous) | Not Reviewed | Non-Preferred |
| Multiple Sclerosis Agents | Bafiertam Capsule Dr (Oral) | Not Reviewed | Preferred |
| Multiple Sclerosis Agents | Kesimpta (Subcutane.) | Not Reviewed | 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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