Summary of April 2024 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board met Friday, April 26, 2024, to recommend clinical prior authorizations and drugs on the Texas Medicaid Preferred Drug List. Information now available online includes the following:
- A recording of this meeting's webcast
- A report of this quarter's clinical prior authorization and PDL recommendations
- Approved revised minutes from the Friday, Oct. 13, 2023, meeting
- Approved minutes from the Friday, January 26, 2024, meeting
- Approved revised DUR Board bylaws
- The PDL drug class review schedule for the Friday, July 26, 2024, meeting
Clinical Prior Authorization Updates
Clinical prior authorizations may be implemented for traditional Medicaid and managed care at any time:
- HHSC will send a notification when it sets an implementation date 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
- Appetite suppressant agents (PDF)
- New criteria - Phendimetrazine/phentermine (PDF)
- Sphingosine 1-phosphate (S1P) receptor modulators (PDF)
- New criteria - Velsipity
- Vesicular monoamine transporter, type 2 inhibitors (PDF)
- Revision
Approved as presented
- Sphingosine 1-phosphate (S1P) receptor modulators (PDF)
- New criteria - Velsipity
- Vesicular monoamine transporter, type 2 inhibitors (PDF)
- Revision
Approved with recommendations
- Appetite suppressant agents – Phendimetrazine/phentermine (PDF)
- New criteria
- The Board recommended removing the manual checks for body mass index (BMI) values from steps two and three of the criteria and using the diagnosis codes in tables 2 and 3 instead
- New criteria
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 Texas HHSC executive commissioner publishes the final PDL decisions. HHSC will incorporate the approved decisions from the Jan. and April 2024 board meetings into the July 2024 PDL.
MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The April 2024 PDL recommendations are available. Notable changes include:
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Anti-Allergens, Oral | Odactra (sublingual) | Not reviewed | Preferred |
| Antidepressants – Other | ZurZuvae (oral) | Not reviewed | Non-preferred |
| Antihyperuricemics | Colcrys (oral) | Preferred | Non-preferred |
| Antihyperuricemics | Mitigare (oral) | Non-preferred | Preferred |
| Antihyperuricemics | Mitigare (oral) | Non-preferred | Preferred |
| Antivirals | Valcyte tablet (oral) | Preferred | Non-preferred |
| Antivirals | Valganciclovir tablet (oral) | Non-preferred | Preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Abrilada (Adalimumab-AFZB) HW 50mg/ml (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Abrilada (Adalimumab-AFZB) LW 50 mg/ml (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Adalimumab-AACF 50 mg/ml (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Amjevita (Adalimumab-ATTO) 100 mg/ml (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Bimzelx (Bimekizumab-BKZX) (subcutaneous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Cosentyx IV (Secukinumab) (intravenous) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Litfulo (oral) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Omvoh (injection) | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Yuflyma syringe (injection) (CF) 100 mg/ml | Not reviewed | Non-preferred |
| Cytokine and Cell-Adhesion Molecule Antagonists | Zymfentra (infliximab-DYYB) (subcutaneous) | Not reviewed | Non-preferred |
| Lipotropics, Other | Ezetimibe (oral) | Non-preferred | Preferred |
| Lipotropics, Other | Zetia (oral) | Preferred | Non-preferred |
| Thrombopoiesis Stimulating Proteins | Alvaiz (oral) | Not reviewed | Non-preferred |
| Urea Cycle Disorder, Oral | Olpruva (oral) | Not reviewed | Non-preferred |
| Antibiotics, Gastrointestinal | Likmez SUS (oral) | Not reviewed | Non-preferred |
| Oncology, Oral - other | Iwilfin (oral) | Not reviewed | Preferred |
| Oncology, Oral- other | Ogsiveo (oral) | Not reviewed | Preferred |
| Ophthalmics, Anti-Inflammatory Immunomodulators | Vevye (ophthalmic) | Not reviewed | Non-preferred |
| Ulcerative Colitis | Velsipity (oral) | Not reviewed | Non-preferred |
Retrospective Drug Utilization Review Updates
Retrospective DUR provides for the ongoing periodic examination of claims data and other records to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care among prescribing providers, pharmacists, and people associated with specific drugs or groups of drugs. The retrospective review also allows for active and ongoing educational outreach to educate prescribing providers on common drug therapy problems with the aim of improving prescribing or dispensing practices.
The Texas Drug Utilization Review Board reviews and recommends interventions for traditional Medicaid claims. A fixed-number of interventions are performed each calendar year. MCOs are required to create and perform interventions and education of their population.
Presented
- Asthma management (PDF)
- Gabapentinoids drug use evaluation (PDF)
- Psychotropic polypharmacy (PDF)
- Support Act criteria (PDF)
Approved as presented
- Asthma management
- Support Act criteria
Approved with recommendations
- Psychotropic polypharmacy
- Add mood stabilizers to the list of drugs to be screened
Tabled
- Gabapentinoids drug use evaluation
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 submitting written materials to the board, and directions about publicly testifying before the board are available on the VDP website.