The Texas Drug Utilization Review Board met Friday, April 28, 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. 20, meeting
- The PDL drug class review schedule for the Thursday, Oct. 12 and Friday, Oct. 13 meetings
Clinical Prior Authorization Updates
Presented:
- Antimigraine Agents, Ergot Derivatives (PDF)
- New criteria
- Cytokine and CAM Antagonists (PDF)
- Revisions:
- Rinvoq (revision for new diagnosis)
- Skyrizi (revision for new diagnosis)
- Sotyktu (add criteria)
- Revisions:
- Erythropoiesis-Stimulated Agents (PDF)
- Mircera (new criteria)
- Reblozyl (new criteria)
- Gattex (teduglutide) (PDF)
- New criteria
Approved as presented:
- Antimigraine Agents, Ergot Derivatives (PDF)
- New criteria
- Erythropoiesis-Stimulating Agents (PDF)
- Mircera (new criteria)
- Reblozyl (new criteria)
- Gattex (teduglutide) (PDF)
- New criteria
Approved with recommendations:
- Cytokine and CAM Antagonists (PDF)
- Revisions
- Added therapy with 14 days or more of greater than 80 mg/day prednisone or prednisone equivalent to potent immunosuppressant therapy
- Revisions
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 January 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 |
---|---|---|---|
Anti-Allergens, Oral | Oralair (sublingual) | Non-preferred | Preferred |
Anti-Allergens, Oral | Palforzia titration capsule (oral) | Non-preferred | Preferred |
Anticoagulants | Pradaxa pellet pack (oral) | Non-reviewed | Non-preferred |
Anticoagulants | Xarelto suspension (oral) | Non-preferred | Preferred |
Antidepressants, other | Venlafaxine Besylate ER (oral) | Non-reviewed | Non-preferred |
Antidepressants, other | Viibryd (oral) | Non-preferred | Preferred |
Antivirals, oral | Valcyte tablet (oral) | Non-preferred | Preferred |
Antivirals, oral | Valganciclovir tablet (oral) | Preferred | Non-preferred |
Bronchodilators, beta agonist | Serevent (inhalation) | Non-preferred | Preferred |
Bronchodilators, beta agonist | Xopenex HFA (inhalation) | Non-preferred | Preferred |
Bronchodilators, beta agonist | Xopenex neb soln (inhalation) | Non-preferred | Preferred |
Cough and Cold, non-narcotic | Duraflu tablet OTC (oral) | Non-preferred | Preferred |
Cough and Cold, non-narcotic | POLYTUSSIN DM OTC (Oral) | Non-preferred | Preferred |
Cough and Cold, non-narcotic | Vanacof DMX Liquid OTC (oral) | Non-preferred | Preferred |
Cytokine and CAM Antagonists | Amjevita autoinjector HC (subcutaneous) | Non-reviewed | Non-preferred |
Cytokine and CAM Antagonists | Amjevita autoinjector LC (subcutaneous) | Non-reviewed | Non-preferred |
Cytokine and CAM Antagonists | Amjevita syringe (subcutaneous) | Non-reviewed | Non-preferred |
Hemophilia Treatment | Hemgenix (intraven) | Non-reviewed | Preferred |
Immunomodulators, Asthma | Tezspire pen (subcutaneous) | Non-reviewed | Non-preferred |
Immunomodulators, Atopic Dermatitis | Protopic (topical) | Preferred | Non-preferred |
Immunomodulators, Atopic Dermatitis | Tacrolimus (AG) (topical) | Non-preferred | Preferred |
Immunomodulators, Atopic Dermatitis | Tacrolimus (topical) | Non-preferred | Preferred |
Lipotropics, other | Praluent pen (subcutaneous) | Non-preferred | Preferred |
Lipotropics, other | Repatha pushtronex (subcutaneous) | Non-preferred | Preferred |
Lipotropics, other | Repatha sureclick (subcutaneous) | Non-preferred | Preferred |
Lipotropics, other | Repatha syringe (subcutaneous) | Non-preferred | Preferred |
Lipotropics, other | Vascepa (oral) | Non-preferred | Preferred |
Pediatric Vitamin Preparations | Pedi Mvi No.17 with fluoride chew (oral) | Non-preferred | Preferred |
Pediatric Vitamin Preparations | PNV NO.15/IRON FUM & PS CMP/FA (Oral) | Non-preferred | Preferred |
Pediatric Vitamin Preparations | Prenatal Vit #76/Iron,Carb/FA (Oral) | Non-preferred | Preferred |
Pediatric Vitamin Preparations | Prenate Enhance (Oral) | Non-preferred | Preferred |
Thrombopoiesis Stimulating Proteins |
Promacta suspension (oral) Age Exception: 12 years and under |
Non-preferred | Non-preferred |
Urea Cycle Disorders, Oral | Carbaglu (oral) | Non-preferred | Preferred |
Urea Cycle Disorders, Oral | Pheburane (oral) | Non-preferred | Preferred |
Antifungals, oral | Noxafil suspdr pkt (oral) | Non-reviewed | Non-preferred |
Colony Stimulating Factors | Rolvedon syringe (subcutaneous) | Non-reviewed | Non-preferred |
Colony Stimulating Factors | Stimufend syringe (subcutaneous) | Non-reviewed | Non-preferred |
HIV / AIDS | Sunlenca tablet (oral) | Non-reviewed | Preferred |
Hypoglycemics, insulin and related agents | Basaglar tempo pen (subcutane.) | Non-reviewed | Non-preferred |
Hypoglycemics, insulin and related agents | Humalog tempo pen (subcutane.) | Non-reviewed | Non-preferred |
Hypoglycemics, insulin and related agents | Lyumjev tempo pen (subcutane.) | Non-reviewed | Non-preferred |
Additional Updates
Review the DUR board documents for the following:
- Jan. 20 Preferred Drug List Decisions
- Jan. 20 Drug Utilization Review Board Meeting minutes
- April 28 Preferred Drug List Recommendations
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.