October 2022 Drug Utilization Review Board Meeting Summary

November 1, 2022

The Texas Drug Utilization Review Board met Friday, October 21, 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, July 22, meeting
  • The PDL drug class review schedule for the Friday, January 20 meeting

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 HHSC.

Presented

Approved as Presented

Approved with Recommendations

  • Androgenic Agents (PDF)
    • Step 7: updated upper limit for testosterone levels for refills to less than or equal (≤ )900 ng/dl
  • Antiseizure Agents (PDF)
    • Epidiolex – removed manual diagnosis question (checking for treatment-resistant epilepsy)
    • Fintepla – added stable therapy check
  • Anxiolytics and Sedative/Hypnotics (PDF)
    • Lorazepam 
      • Step 1: updated to allow for approval without a diagnosis for pediatric patients less than 2 years of age
      • Step 7: updated to allow approval for patients with a diagnosis of nausea and vomiting associated with cancer
         

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 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 October 2022 PDL recommendations are available. Notable changes include:

PDL Class Drug Current PDL Status Recommended Status
Androgenic Agents Androderm (transderm) Non-preferred Preferred
Antibiotics, vaginal Xaciato (vaginal) Non-reviewed Non-preferred
Antiemetics/Antivertigo agents Diclegis (oral) Non-preferred Preferred
Antiemetics/Antivertigo agents Transderm-scop (transderm) Non-Preferred Preferred
Antipsychotics Rexulti (oral) Non-Preferred Preferred
Colony Stimulating Factors Fulphila (subcutaneous) Preferred Non-Preferred
Colony Stimulating Factors Nyvepria (subcutaneous) Non-Preferred Preferred
Epinephrine, self-injected Epipen (intramusc) Non-Preferred Preferred
Epinephrine, self-injected Epipen Jr (intramusc) Non-Preferred Preferred
Hypoglycemics, incretin mimetics/enhancers Mounjaro (subcutane) Non-reviewed Non-Preferred
Hypoglycemics, incretin mimetics/enhancers Ozempic (subcutane) Non-Preferred Preferred
Hypoglycemics, incretin mimetics/enhancers Trijardy XR (oral) Non-Preferred Preferred
Hypoglycemics, metformin Glumetza (oral) Non-Preferred Preferred
Hypoglycemics, metformin Metformin ER (Glumetza) (oral) Preferred Non-Preferred
Hypoglycemics, SLGT2 Invokamet (oral) Non-preferred Preferred
Macrolides-Ketolides E.E.S. 200 suspension (oral) Preferred Non-preferred
Macrolides-Ketolides Eryped 200 suspension (oral) Non-Preferred Preferred
Tetracyclines Doxycycline Monohydrate 100 mg capsule (AG) (oral) Non-preferred Preferred
Tetracyclines Doxycycline Monohydrate 50 mg capsule (AG) (oral) Non-Preferred Preferred
Oncology, oral - Hematologic Vonjo (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.