January 2021 Drug Utilization Review Board Meeting Summary

Published on
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:

Approved as presented:

  • Apokyn and Kynmobi (dopamine agonists)
  • Evrysdi (oral solution)

Approved with recommendations:

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.