July 2022 Drug Utilization Review Board Meeting Summary

Published on
August 4, 2022

The Texas Drug Utilization Review Board met Friday, July 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, April 22, meeting
  • The PDL drug class review schedule for the Friday, October 21 meeting

Clinical Prior Authorization Updates

Presented:

Approved as presented:

Approved with recommendations:

  • Allergen Extracts – Oralair (PDF)
    • Revised criteria
      • Step 5: change the lookback time frame for auto-injectable epinephrine to 730 days
      • Step 6: change the lookback period to 730 days and add “‘use of combination product (intranasal corticosteroid/intranasal antihistamine) ” to the list of prior therapy
  • Sodium-glucose cotransporter-2 (SGLT2) (PDF)
    • Farxiga (dapagliflozin) and Jardiance (empagliflozin)
      • Revised criteria
        • Step 3:  Changed the lookback time frame for kidney transplant to 730 days

Clinical prior authorizations may implement for traditional Medicaid and Medicaid managed care at any time:

  • HHSC will notify pharmacy providers and stakeholders once we set an implementation date 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 Texas HHS executive commissioner releases the final decision. HHSC will incorporate the approved decisions from the July and October 2022 board meetings into the January 2023 PDL. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.

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

PDL Class Drug Current PDL Status Recommended Status
Alzheimer’s Agents Adlarity (transderm) Non-reviewed Non-preferred
Calcium Channel Blockers Norliqva (oral) Non-reviewed Non-preferred
Cytokine and CAM Antagonists Cibinqo (oral) Non-reviewed Non-Preferred
Fluoroquinolones, oral Cipro suspension (oral) Non-Preferred Preferred
Fluoroquinolones, oral Ciprofloxacin suspension (oral) Preferred Non-Preferred
Glucocorticoids, oral Tarpeyo (oral) Non-reviewed Non-Preferred
Immunosuppressives, oral Tavneos (oral) Non-reviewed Non-preferred
Non-steroidal anti-Infallatory Drugs (NSAIDs) Diclofenac sodium (oral) Non-Preferred Preferred
Non-steroidal anti-Infallatory Drugs (NSAIDs) Ketorolac (oral) Non-Preferred Preferred
Non-steroidal anti-Infallatory Drugs (NSAIDs) Sulindac (oral) Non-Preferred Preferred
Ophthalmic Antibiotics Vigamox (ophthalmic) Non-Preferred Preferred
Ophthalmic Antibiotic-Steroid Combinations Tobradex suspension (ophthalmic) Non-Preferred Preferred
Ophthalmics for Allergic Conjunctivitis Lastacaft, OTC (ophthalmic) Non-reviewed Non-Preferred
Ophthalmics for Allergic Conjunctivitis Olopatadine, OTC (pataday once daily) (ophthalmic) Non-Preferred Preferred
Ophthalmics for Allergic Conjunctivitis Olopatadine, OTC (pataday twice daily) (ophthalmic) Non-Preferred Non-Preferred
Rosacea Agents, topical Epsolay (topical) Non-reviewed Non-Preferred
Skeletal Muscle Relaxants Fleqsuvy (oral) Non-reviewed Non-preferred
Skeletal Muscle Relaxants Lyvispah (oral) Non-reviewed Non-Preferred
Ulcerative Colitis Canasa (rectal) Non-preferred Preferred
Ulcerative Colitis Mesalamine (Canasa) (AG) (rectal) Preferred Non-preferred
Ulcerative Colitis Mesalamine (Canasa) (rectal) Preferred Non-Preferred
Ulcerative Colitis Pentasa (oral) Non-preferred Preferred
Uterine Disorder Treatments (new PDL class) Myfembree (oral) Non-reviewed Preferred
Uterine Disorder Treatments (ew PDL class) Oriahnn (oral) Non-reviewed Preferred
Uterine Disorder Treatments (new PDL class) Orilissa (oral) Non-reviewed Preferred

Single drug reviews

PDL Class Drug Current PDL Status Recommended Status
Acne Agents, topical Twyneo, cream (topical) Non-reviewed Non-Preferred
Analgesics, narcotics short Seglentis (oral) Non-reviewed Non-Preferred
Antivirals, orals Livtencity (oral) Non-reviewed Non-Preferred
Colony Stimulating Factors Releuko, syringe (subcutaneous) Non-reviewed Non-Preferred
Colony Stimulating Factors Releuko, vial (injection) Non-reviewed Non-Preferred
Gastrointestinal (GI) Motility, chronic Ibsrela, tablet (oral) Non-reviewed Non-Preferred
Hereditary Angiodeema (HAE) Treatments Takhzyro, syringe (sub-q) Non-reviewed Non-Preferred
HIV/AIDS Triumeq PD tab suspension (oral) Non-reviewed Preferred
Opiate Dependence Treatments Zimhi (injection) Non-reviewed Preferred

Additional Updates

DUR Board chair and vice-chair elections:

  • Chairman: Alex D. Kudisch. M.D., D.F.A.P.A
  • Vice-chair: Jennifer Fix, PharmD.

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.