Summary of April 2023 Drug Utilization Review Board Meeting Now Available

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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:

Approved as presented:

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

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.