November 2021 Drug Utilization Review Board Meeting Summary

Published on
November 18, 2021

The Texas Drug Utilization Review Board met Friday, November 12, to recommend clinical prior authorizations and drugs 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 Friday, July 23, meeting
  • The PDL drug class review schedule for the Friday, January 21 meeting

Clinical Prior Authorization Updates

Presented

Approved as presented

Approved with recommendations

  • Antipsychotic agents (PDF)
    • Add new criteria for Lybalvi
    • Replace step #10 with a question to check for long-term opioid therapy ( 90 days or more in the last 120 days)

Tabled

  • SGLT2 (PDF)
    • Farxiga (revised criteria)
    • Jardiance (revised criteria)

Reminders:

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 identifies which prior authorizations are utilized by each MCO and how those relate to those used by the Vendor Drug Program.

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. HHSC-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 November 2021 PDL recommendations are available. Notable changes include:

PDL Class Drug Current PDL Status Recommended Status
Anticonvulsants Elepsia XR tablet (oral) Non-Reviewed Preferred
Anticonvulsants Rufinamide suspension (oral) Non-Reviewed Preferred
Anticonvulsants Rufinamide tablet (oral) Non-Reviewed Preferred
Antipsychotics Perseris (subcutaneous) Non-Preferred Preferred
Antipsychotics Vraylar (oral) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart cartridge (AG) (subcutaneous) Preferred Non-Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart vial (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart/Insulin Aspart Protamine insulin pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Aspart/Insulin Aspart Protamine vial (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro Junior Kwikpen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro pen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro Protamine Mix Kwikpen (AG) (subcutaneous) Non-Preferred Preferred
Hypoglycemics, Insulin and Related Agents Insulin Lispro vial (AG) (subcutaneous) Non-Preferred Preferred
Opiate Dependence Treatments Kloxxado spray (nasal) Non-Reviewed Preferred
Glucagon Agents Zegalogue autoinjector (subcutaneous) Non-Reviewed Non-Preferred
Immunosuppressives Benlysta autoinjector (subcutane) Non-Reviewed Non-Preferred
Immunosuppressives Benlysta Syringe (subcutane) Non-Reviewed Non-Preferred
Immunosuppressives Lupkynis (oral) Non-Reviewed Non-Preferred
Oncology, Oral - Lung Lumakras (oral) Non-Reviewed Preferred
Oncology, Oral - Other Truseltiq (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.