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, Jan. 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:
- Atopic Dermatitis
- Add new criteria for Adbry (tralokinumab-ldrm) (PDF)
- Recorlev (levoketoconazole oral tablets) (PDF)
- New criteria for Cushing Disease
- Tyrvaya (varenicline nasal) (PDF)
- New criteria for dry eye
- Voxzogo (vosoritide) (PDF)
- New criteria for achondroplasia
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
- Add new criteria for Cibinqo (abrocitinib) (PDF)
- 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.
- New criteria for cholestatic pruritis due to Alagille syndrome
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 Jan. 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.