April 2022 Drug Utilization Review Board Meeting Summary

Published on
May 5, 2022

The Texas Drug Utilization Review Board met Friday, April 22, to make recommendations about 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, January 21, meeting
  • The PDL drug class review schedule for the Friday, July 22 meeting
  • The DUR Board Handbook, with the Conflict of Interest Policy and revised bylaws

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

Presented:

  • Atopic Dermatitis
    • Add Cibinqo (abrocitinib) and Adbry (tralokinumab-ldrm)
  • Livmarli (maralixibat)
    • New criteria for cholestatic pruritis due to Alagille syndrome
  • Recorlev (levoketoconazole oral tablets)
    • New criteria for Cushing Disease
  • Tyrvaya (varenicline nasal)
    • New criteria for dry eye
  • Voxzogo (vosoritide)
    • New criteria for achondroplasia

Approved as presented:

Approved with recommendations:

  • Atopic Dermatitis
    • Add new criteria for Cibinqo (abrocitinib) (PDF)
      • Step 3, include a history of a 30-day treatment with a systemic corticosteroids therapy in a 90-lookback period  
      • VDP will extend the systemic steroid recommendations to other JAK inhibitors in the class (Rinvoq) and will provide advance notice of the implementation timeline
  • Livmarli (maralixibat) (PDF)
    • New criteria for cholestatic pruritis due to Alagille syndrome
      • DUR Board recommended modifications to Step 6 which is related to the patient’s international normalized ratio (INR), and due to concerns voiced at the meeting, VDP has decided to remove Step 6.
      • VDP has decided to remove the patient’s international normalized ratio (INR) related step (similar to Livmarli) and will provide advance notice of the implementation timeline.

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 will incorporate the approved decisions from the January and April 2022 board meetings into the July 2022 PDL. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

The April 2022 PDL recommendations are available. Notable changes include:

PDL Class Drug Current PDL Status Recommended Status
Anticoagulants Xarelto suspension (oral) Non-reviewed Non-preferred
Antivirials, oral Valcyte tablet (oral) Preferred Non-preferred
Antivirials, oral Valganciclovir tablet (oral) Non-preferred Preferred
Cough and cold, non-narcotic Vanacof DMX liquid otc (oral) Preferred Non-preferred
Erythropoiesis Stimulating Proteins Erythropoiesis stimulating proteins Non-preferred Preferred
Glucocorticoids, inhaled Pulmicort Flexhaler (inhalation) Non-preferred Preferred
Immune Globulins Cytogam (intraven) Preferred Non-preferred
Immune Globulins Gamastan S-D vial (intramusc) Preferred Non-preferred
Immune Globulins Hepagam B (intramusc) Preferred Non-preferred
Immune Globulins Hizentra vial (subcutaneous) Preferred Non-preferred
Immune Globulins Varizig (intramusc) Preferred Non-preferred
Immunomodulators, Asthma Xolair syringe (sub-q) Non-reviewed Preferred
Lincosamides/Oxazolidinones/Streptogramins Linezolid suspension (AG) (oral) Preferred Non-preferred
Lincosamides/Oxazolidinones/Streptogramins Linezolid suspension (oral) Preferred Non-preferred
Lipotropics, other Colestid tablet (oral) Non-preferred Preferred
Lipotropics, other Colestipol tablet (oral) Preferred Non-preferred
Lipotropics, statins Lipitor (oral) Non-preferred Preferred
Prenatal Vitamins Citranatal B-calm (oral) Non-preferred Preferred
Pulmonary Arterial Hypertension (PAH) agents, oral and inhaled Ambrisentan (oral) Preferred Non-preferred
PAH agents, oral and inhaled Letairis (oral) Non-preferred Preferred
PAH agents, oral and inhaled Revatio tablet (oral) Non-preferred Preferred
PAH agents, oral and inhaled Sildenafil tablet (oral) Preferred Non-preferred
Antiparkinson's agents Dhivy tablet (oral) Non-reviewed Non-preferred
Anticonvulsants Eprontia solution (oral) Preferred Preferred
Growth Hormone  Skytrofa cartridge (subcutaneous) Non-reviewed Non-preferred
Immunomodulators, atopic dermatitis Adbry (subcutaneous) Non-reviewed Non-preferred
Ophthalmics, anti-inflammatory/immunomodulator Tyrvaya spray (nasal) Non-reviewed Non-preferred
Ophthalmics, glaucoma agents Vuity (ophthalmic) Non-reviewed Non-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.