The Texas Drug Utilization Review Board met Friday, Jan. 20, 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, Oct. 21, meeting
- The PDL drug class review schedule for the Friday, April 28 meeting
Clinical Prior Authorization Updates
Presented:
- Antiseizure Agents (PDF)
- Ztalmy (ganaxolone) – add new criteria
- Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder {PDF}
- Revision of current non-stimulants criteria
- Cytokine and CAM Antagonists {PDF}
- Olumiant - Add criteria for the new indication alopecia areata
- Multiple Sclerosis Agents {PDF}
- Tascenso ODT (fingolimod) – add new criteria
- Opioid/Benzoiazepein/Muscle Relaxants Combinations (PDF)
- Revision of current criteria
- Topical Immunomodulators (PDF)
- Opzelura - Add criteria for the new indication (vitiligo)
Approved as presented:
- Antiseizure Agents (PDF)
- Ztalmy (ganaxolone) – add new criteria
- Attention Deficit Disorder/ Attention Deficit Hyperactivity Disorder (PDF)
- Revision of current non-stimulants criteria
- Cytokine and CAM Antagonists (PDF)
- Olumiant - Add criteria for the new indication alopecia areata
- Topical Immunomodulators (PDF)
- Opzelura - Add criteria for the new indication (vitiligo)
Approved with recommendations:
- Multiple Sclerosis Agents (PDF)
- Tascenso ODT (fingolimod) – add new criteria
- Changed check for the functional pacemaker to a manual step to require providers to indicate that the pacemaker is functional.
- Tascenso ODT (fingolimod) – add new criteria
- Opioid/Benzodiazepine/Muscle Relaxants Combinations) (PDF)
- Revision of current criteria
- Changed overlap to 10 days vs. the 7 days presented. Board requested a report detailing the number of members affected for the April 2023 DURB meeting
- Revision of current criteria
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.
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 2023 board meetings into the July 2023 PDL. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The Jan. 2023 PDL recommendations are available. Notable changes include:
PDL Class | Drug | Current PDL Status | Recommended Status |
---|---|---|---|
Antimigraine Agents, other | Ubrelvy (oral) | Non-preferred | Preferred |
Bladder Relaxant Preparations | Myrbetriq (oral) | Non-preferred | Preferred |
Bladder Relaxant Preparations | Myrbetriq granules (oral) | Non-preferred | Preferred |
Glucagon Agents | Gvoke pen (subcutaneous) | Non-preferred | Preferred |
Glucagon Agents | Gvoke syringe (subcutaneous) | Preferred | Non-preferred |
Intranasal Rhinitis Agents | Ryaltris (nasal) | Not reviewed | Non-preferred |
Movement Disorders | Tetrabenazine (oral) | Preferred | Non-preferred |
Movement Disorders | Xenazine (oral) | Non-preferred | Preferred |
Pulmonary Arterial Hypertension Agents, oral and inhaled | Tadliq suspension (oral) | Not reviewed | Non-preferred |
Stimulants and Related Agents | Dyanavel XR tablet (oral) | Not reviewed | Non-preferred |
Stimulants and Related Agents | Quillichew ER (oral) | Preferred | Non-preferred |
Stimulants and Related Agents | Xelstrym (transdermal) | Not reviewed | Non-preferred |
Anticonvulsants | Zonisade (oral) | Not reviewed | Preferred |
Anticonvulsants | Ztalmy (oral) | Not reviewed | Preferred |
Antidepressants, other | Auvelity (oral) | Not reviewed | Non-preferred |
Benign Prostatic Hyperplasia Treatments | Entadfi (oral) | Not reviewed | Non-preferred |
Colony Stimulating Factor | Fylnetra (subcutaneous) | Not reviewed | Non-preferred |
Cytokine and Cam Antagonists | Skyrizi on-body (subcutaneous) | Not reviewed | Non-preferred |
Cytokine and Cam Antagonists | Sotyktu (oral) | Not reviewed | Non-preferred |
Multiple Sclerosis Agents | Tascenso ODT (oral) | Not reviewed | Preferred |
Urea Cycle Disorders, oral | Pheburane (oral) | Not 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.