Summary of Oct. 2023 Drug Utilization Review Board Meeting Now Available
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The Texas Drug Utilization Review Board met Thursday, Oct. 12, and Friday, Oct. 13, to recommend 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 21, meeting
- The PDL drug class review schedule for the Friday, Jan. 26, 2024, meeting
Clinical Prior Authorization Updates
Clinical prior authorizations may implement for traditional Medicaid and managed care at any time:
- Providers and stakeholders will be notified once an implementation date has been set for traditional Medicaid.
- Refer to MCO Search for a link to each MCO’s clinical prior authorization page.
- 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
- Antipsychotics (ASY) Agents (PDF)
- Revisions
- Anxiolytics and Sedative-Hypnotics (ASH) Agents (PDF)
- Revisions
- Cytokine and CAM Antagonists (PDF)
- New criteria for Litfulo (Ritlecitinib)
- Calcitonin Gene-Related Peptide Receptor (CGRP) (PDF)
- New criteria for Zavzpret (Zavegepant)
- Filspari (Sparsentan) (PDF)
- New Criteria
- Imcivree (Setmelanotide) (PDF)
- New Criteria
- Rezurock (Belumosudil) (PDF)
- New criteria
- Skyclarys (Omaveloxolone) (PDF)
- New criteria
- Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors (PDF)
- Revision of current criteria
- Hormonal Therapy Agents (PDF)
- New criteria
Approved as presented
- Anxiolytics and Sedative-Hypnotics (ASH) Agents (PDF)
- Cytokine and CAM Antagonists (PDF)
- New criteria for Litfulo (Ritlecitinib)
- Filspari (Sparsentan) (PDF)
- Skyclarys (Omaveloxolone) (PDF)
- New criteria
Approved with recommendations
- Antipsychotics (ASY) Agents (PDF)
- Removed insomnia diagnosis from criteria
- Updated step 15 duplicate therapy check to 2 or more antipsychotics with unique active pharmaceutical agents
- Calcitonin Gene-Related Peptide Receptor (CGRP) Antagonists (Acute Treatment) (PDF)
- New criteria for Zavzpret (Zavegepant)
- Add to step 9 check for routine prophylactic therapy; if found, approve for 365 days; if not found, approve for 90 days
- Added this logic for both Nurtec ODT and Ubrelvry
- Refined wording for step 6 to check for concurrent use of contraindicated drugs for Nurtec ODT, Ubrelvry, and Zavzpret (Zavegepant)
- New criteria for Zavzpret (Zavegepant)
- Imcivree (Setmelanotide) (PDF)
- Updated step 4; if yes, go to step 6
- Added ICD10 Code Q87.83 for Bardet-Biedl syndrome for Imcivree to step 4
- Rezurock (Belumosudil) (PDF)
- For initial requests, approve for 90 days
- For renewal requests, approve for 365 days, remove prior systemic therapy (step 3), and remove steps for age check and diagnosis check
- Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors (PDF)
- Changed step 5 for each drug to check for prior antipsychotic therapy to a check for prior dopamine blocking therapy
- Added Generic Code Numbers (GCNs) for metoclopramide to the step 5 table
Not approved as presented
- Hormonal Therapy Agents
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 Oct. 2023 board meeting into the Jan. 2024 PDL. MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The Oct. 2023 PDL recommendations are available. Notable changes include:
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Cephalosporins and Related Antibiotics | Cefpodoxime Suspension (Oral) | Non-preferred | Preferred |
| Cephalosporins and Related Antibiotics | Cefpodoxime Tablet (Oral) | Non-preferred | Preferred |
| Ophthalmics, Anti-Inflammatory/Immunomodulators | Miebo (Ophthalmic) | Non-reviewed | Preferred |
| Ophthalmics, Anti-Inflammatory/Immunomodulators | Verkazia (Ophthalmic) | Non-reviewed | Preferred |
| Antibiotics, Gastrointestinal | Vowst Capsule (Oral) | Non-reviewed | Non-preferred |
| Antifungals, Oral | Noxafil Tablet (Oral) | Preferred | Non-preferred |
| Antifungals, Oral | Posaconazole Suspension (AG) (Oral) | Non-preferred | Preferred |
| Antifungals, Oral | Posaconazole Suspension (Oral) | Non-preferred | Preferred |
| Antifungals, Oral | Posaconazole Tablet (AG) (Oral) | Non-preferred | Preferred |
| Antifungals, Oral | Posaconazole Tablet (Oral) | Non-preferred | Preferred |
| Antifungals, Oral | Posaconazole Tablet (AG) (Oral) | Non-preferred | Preferred |
| Antifungals, Oral | Posaconazole Tablet (Oral) | Non-preferred | Preferred |
| Antipsychotics | Abilify Asimtufii (Intramusc) | Non-preferred | Non-preferred |
| Antipsychotics | Caplyta (Oral) | Non-preferred | Preferred |
| Antipsychotics | Invega Hafyera (Intramusc) | Preferred | Non-preferred |
| Antipsychotics | Invega Trinza (Intramusc) | Preferred | Non-preferred |
| Antipsychotics | Latuda (Oral) | Preferred | Non-preferred |
| Antipsychotics | Lurasidone (Oral) | Non-preferred | Preferred |
| Antipsychotics | Nuplazid Capsule (Oral) | Non-preferred | Preferred |
| Antipsychotics | Uzedy (Subcutaneous) | Non-reviewed | Non-preferred |
| Epinephrine, Self-Injected | Auvi-Q 0.1 mg (Intramusc) | Non-reviewed | Preferred |
| Epinephrine, Self-Injected | Auvi-Q 0.15 mg (Intramusc) | Non-preferred | Preferred |
| Epinephrine, Self-Injected | Auvi-Q 0.3 mg (Intramusc) | Non-preferred | Preferred |
| Growth Hormone | Ngenla Pen (Injection) | Non-reviewed | Non-preferred |
| Growth Hormone | Skytrofa cartridge (Subcutaneous) | Non-preferred | Preferred |
| Growth Hormone | Sogroya (Subcutaneous) | Non-reviewed | Non-preferred |
| Hypoglycemics, Incretin Mimetics/Enhancers | Janumet XR (Oral) | Non-preferred | Preferred |
| Hypoglycemics, Incretin Mimetics/Enhancers | Jentadueto XR (Oral) | Non-preferred | Preferred |
| Hypoglycemics, SLGT2 | Inpefa (Oral) | Non-reviewed | Non-preferred |
| Hypoglycemics, SLGT2 | Invokamet XR (Oral) | Non-preferred | Preferred |
| Opiate Dependence Treatments | Opvee Spray (Nasal) | Non-reviewed | Preferred |
| Antimigraine Agents, Other | Zavzpret (Nasal) | Non-reviewed | Non-preferred |
| Cytokine and CAM Antagonists |
| Non-reviewed | Non-preferred |
| Hemophilia Treatment | Altuviiio (Intraven) | Non-reviewed | Preferred |
| Movement Disorders | Austedo Xr (Oral) | Non-reviewed | Preferred |
| Movement Disorders | Austedo Xr Titr Pk (Oral) | Non-reviewed | Preferred |
| Oncology, Oral - Breast | Orserdu (Oral) | Non-reviewed | Preferred |
| Oncology, Oral - Hematologic | Rezlidhia (Oral) | Non-reviewed | Preferred |
| Oncology, Oral - Hematologic | Vanflyta (Oral) | Non-reviewed | Preferred |
| Oncology, Oral - Lung | Krazati (Oral) | Non-reviewed | Preferred |
| Oncology, Oral – Skin | Mekinist Solution (Oral) | Non-reviewed | Preferred |
| Oncology, Oral - Skin | Tafinlar Suspension (Oral) | Non-reviewed | Preferred |
| PAH Agents, Oral and Inhaled | Orenitram Titration Kit (Oral) | Non-reviewed | Non-preferred |
| Proton Pump Inhibitors | Konvomep (Oral) | Non-reviewed | Non-preferred |
| Sedative Hypnotics | Zolpidem Capsule (Oral) | Non-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.