Summary of Oct. 2023 Drug Utilization Review Board Meeting Now Available

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.


Approved as presented

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)
  • 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 ClassDrugCurrent PDL StatusRecommended Status
Cephalosporins and Related AntibioticsCefpodoxime Suspension (Oral)Non-preferredPreferred
Cephalosporins and Related AntibioticsCefpodoxime Tablet (Oral)Non-preferredPreferred
Ophthalmics, Anti-Inflammatory/ImmunomodulatorsMiebo (Ophthalmic)Non-reviewedPreferred
Ophthalmics, Anti-Inflammatory/ImmunomodulatorsVerkazia (Ophthalmic)Non-reviewedPreferred
Antibiotics, GastrointestinalVowst Capsule (Oral)Non-reviewedNon-preferred
Antifungals, OralNoxafil Tablet (Oral)PreferredNon-preferred
Antifungals, OralPosaconazole Suspension (AG) (Oral)Non-preferredPreferred
Antifungals, OralPosaconazole Suspension (Oral)Non-preferredPreferred
Antifungals, OralPosaconazole Tablet (AG) (Oral)Non-preferredPreferred
Antifungals, OralPosaconazole Tablet (Oral)Non-preferredPreferred
Antifungals, OralPosaconazole Tablet (AG) (Oral)Non-preferredPreferred
Antifungals, OralPosaconazole Tablet (Oral)Non-preferredPreferred
AntipsychoticsAbilify Asimtufii (Intramusc)Non-preferredNon-preferred
AntipsychoticsCaplyta (Oral)Non-preferredPreferred
AntipsychoticsInvega Hafyera (Intramusc)PreferredNon-preferred
AntipsychoticsInvega Trinza (Intramusc)PreferredNon-preferred
AntipsychoticsLatuda (Oral)PreferredNon-preferred
AntipsychoticsLurasidone (Oral)Non-preferredPreferred
AntipsychoticsNuplazid Capsule (Oral)Non-preferredPreferred
AntipsychoticsUzedy (Subcutaneous)Non-reviewedNon-preferred
Epinephrine, Self-InjectedAuvi-Q 0.1 mg (Intramusc)Non-reviewedPreferred
Epinephrine, Self-InjectedAuvi-Q 0.15 mg (Intramusc)Non-preferredPreferred
Epinephrine, Self-InjectedAuvi-Q 0.3 mg (Intramusc)Non-preferredPreferred
Growth HormoneNgenla Pen (Injection)Non-reviewedNon-preferred
Growth HormoneSkytrofa cartridge (Subcutaneous)Non-preferredPreferred
Growth HormoneSogroya (Subcutaneous)Non-reviewedNon-preferred
Hypoglycemics, Incretin Mimetics/EnhancersJanumet XR (Oral)Non-preferredPreferred
Hypoglycemics, Incretin Mimetics/EnhancersJentadueto XR (Oral)Non-preferredPreferred
Hypoglycemics, SLGT2Inpefa (Oral)Non-reviewedNon-preferred
Hypoglycemics, SLGT2Invokamet XR (Oral)Non-preferredPreferred
Opiate Dependence TreatmentsOpvee Spray (Nasal)Non-reviewedPreferred
Antimigraine Agents, OtherZavzpret (Nasal)Non-reviewedNon-preferred
Cytokine and CAM Antagonists
  • Adalimumab-FKJP Kit (Injection) (CF) 50 mg/ml
  • Adalimumab-FKJP Pen Kit (Injection) (Cf) 50 mg/ml
  • Cosentyx Unoready Pen (Subcutane)
  • Cyltezo Kit (Injection) (CF) 50 mg/ml
  • Cyltezo Pen Kit (injection)  
    Hadlima Kit (injection) (CF) 100 mg/ml 
    Hadlima Kit (injection) 50 mg/ml
  • Hadlima Pen Kit (injection) (CF) 100 mg/ml
  • Hadlima Pen Kit (Injection) 50 mg/ml
  • Hulio Kit (injection)
  • Hulio Pen Kit (injection)
  • Hyrimoz Kit (injection) (CF) 100 mg/ml
  • Hyrimoz Pen Kit (injection) (CF) 100 mg/ml
  • Idacio Kit (injection)
  • Idacio Pen Kit (injection)
  • Yuflyma Pen Kit (injection) (CF) 100 mg/ml
  • Yusimry (CF) Pen (subcutaneous)
Hemophilia TreatmentAltuviiio (Intraven)Non-reviewedPreferred
Movement DisordersAustedo Xr (Oral)Non-reviewedPreferred
Movement DisordersAustedo Xr Titr Pk (Oral)Non-reviewedPreferred
Oncology, Oral - BreastOrserdu (Oral)Non-reviewedPreferred
Oncology, Oral - HematologicRezlidhia (Oral)Non-reviewedPreferred
Oncology, Oral - HematologicVanflyta (Oral)Non-reviewedPreferred
Oncology, Oral - LungKrazati (Oral)Non-reviewedPreferred
Oncology, Oral – SkinMekinist Solution (Oral)Non-reviewedPreferred
Oncology, Oral - SkinTafinlar Suspension (Oral)Non-reviewedPreferred
PAH Agents, Oral and InhaledOrenitram Titration Kit (Oral)Non-reviewedNon-preferred
Proton Pump InhibitorsKonvomep (Oral)Non-reviewedNon-preferred
Sedative HypnoticsZolpidem Capsule (Oral)Non-reviewedNon-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.