- A recording of this meeting’s webcast
- A report of this quarter’s clinical prior authorization and PDL recommendations
- Approved minutes from the Friday, April 23, meeting
- The PDL drug class review schedule for the Friday, October 22 meeting
Clinical Prior Authorization Updates
- 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 identifies which prior authorizations are utilized by each MCO and how those relate to those used by the Vendor Drug Program.
- Attention-Deficit / Attention Deficit Hyperactivity Disorder (PDF)
- Add Qelbree
- Multiple sclerosis agents (PDF)
- New criteria for Ponvory (safety checks)
- Phosphate Binders (PDF)
- Criteria revisions
- Sedative/Hypnotics (PDF)
- Criteria revision for Hetlioz
Approved as presented
Approved with recommendations
- Attention-Deficit / Attention Deficit Hyperactivity Disorder - Quelbree (PDF)
- Add check for mood stabilizer if diagnosis of bipolar disorder found in step #3
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 October 2021 board meetings will be incorporated into the PDL published in January 2022. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The July 2021 PDL recommendations are available. Notable changes include:
|PDL Class||Drug||Current PDL Status||Recommended Status|
|Immunosuppressives, oral||Rapamune tablet (oral)||Non-Preferred||Preferred|
|Immunosuppressives, oral||Sirolimus tablet (AG) (oral)||Preferred||Non-Preferred|
|Immunosuppressives, oral||Sirolimus tablet (oral)||Preferred||Non-Preferred|
|Ophthalmics, anti-inflammatories||Lotemax drops (ophthalmic)||Non-Preferred||Preferred|
|Ophthalmics, anti-inflammatory/immunomodulators||Xiidra (ophthalmic)||Non-Preferred||Preferred|
|Platelet Aggregation Inhibitors||Aggrenox (oral)||Preferred||Non-Preferred|
|Platelet Aggregation Inhibitors||Aspirin/Dipyridamole (oral)||Non-Preferred||Preferred|
|Stimulants and related agents||Qelbree (oral)||Non-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 on the VDP website.