Jan. 2023 Drug Utilization Review Board Meeting Summary

February 3, 2023

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:

Approved as presented:

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.
  • 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

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.