April 2021 Drug Utilization Review Board Meeting Summary

Published on
May 12, 2021

The Texas Drug Utilization Review Board met Friday, April 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 Sunday, January 22, meeting
  • The PDL drug class review schedule for the Sunday, July 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:

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 January 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 April 2021 PDL recommendations are available. Notable changes include:

PDL Class Drug Current PDL Status Recommended Status
Antibiotics, Inhaled Arikayce (Inhalation) Preferred Non-Preferred
Anticoagulants Fragmin Disp Syrin (Subcutane)     Preferred Non-Preferred
Antivirals, Oral Relenza (Inhalation) Preferred Non-Preferred
Bronchodilators, Beta Agonist Ventolin Hfa (Inhalation) Non-Preferred Preferred
COPD Agents Anoro Ellipta (Inhalation) Non-Preferred Preferred
COPD Agents Bevespi Aerosphere (Inhalation) Preferred Non-Preferred
Erythropoiesis Stimulating Proteins Epogen (Injection) Preferred Non-Preferred
Glucocorticoids, Inhaled Budesonide 0.25, 0.5 Mg Respules (Inhalation) Non-Preferred Preferred
Glucocorticoids, Inhaled Budesonide 1 Mg Respules (Inhalation) Non-Preferred Preferred
Glucocorticoids, Inhaled Pulmicort 0.25, 0.5 Mg Respules (Inhalation) Preferred Non-Preferred
Glucocorticoids, Inhaled Pulmicort 1 Mg Respules (Inhalation) Preferred Non-Preferred
HAE Treatments Firazyr (Sub-Q) Preferred Non-Preferred
HAE Treatments Icatibant (Subcut) Non-Preferred Preferred
HAE Treatments Orladeyo (Oral) Not reviewed Non-Preferred
Hemophilia Treatment Sevenfact (Intraven) Not reviewed Preferred
Hypoglycemics, Incretin Mimetics/Enhancers Janumet (Oral) Non-Preferred Preferred
Hypoglycemics, Incretin Mimetics/Enhancers Trulicity (Subcutane.) Non-Preferred Preferred
Lipotropics, Other Omega-3 Acid Ethyl Esters (Oral) Non-Preferred Preferred
Multiple Sclerosis Agents Dimethyl Fumarate Dr (Ag) (Oral) Not reviewed Preferred
Multiple Sclerosis Agents Mayzent Dose Pack (Oral) Not reviewed Preferred
Multiple Sclerosis Agents Plegridy (Intramusc.) Not reviewed Preferred
Pediatric Vitamin Preparations Aquadeks Drops Otc (Oral) Not reviewed Preferred
Pediatric Vitamin Preparations Children's Vitamins with Iron Chew OTC (Oral) Not reviewed Non-preferred
Pediatric Vitamin Preparations Poly-Vi-Sol Drops OTC (Oral) Not reviewed Preferred
Pediatric Vitamin Preparations Poly-Vi-Sol with Iron Drops OTC (Oral) Not reviewed Preferred
Prenatal Vitamins Citranatal B-Calm (Oral) Preferred Non-preferred
Prenatal Vitamins Vitafol Tab Chew (Oral) Non-Preferred Preferred
Sickle Cell Anemia Treatments Endari (Oral) Non-Preferred Preferred
Sickle Cell Anemia Treatments Oxbryta (Oral) Non-Preferred Preferred
Sickle Cell Anemia Treatments Siklos (Oral) Non-Preferred Preferred
Thrombopoiesis Stimulating Proteins Promacta Suspension (Oral) Preferred Non-preferred
Colony Stimulating Factors Nyvepria (Subcutaneous) Not reviewed Non-preferred
Ophthalmics For Allergic Conjunctivitis Pataday Xs Once Daily Otc (Ophthalmic) 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.