Summary of July 2024 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board met Friday, July 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 minutes from the Friday, April 26, 2024, meeting
- The PDL drug class review schedule for the Friday, Oct. 25, 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 (PDF) identifies which prior authorizations are utilized by each MCO and how those relate to those used by HHSC.
Presented
- Calcitonin Gene-Related Peptide (CGRP) Prophylaxis (PDF)
- Revision
- Cytokine and CAM Antagonists (PDF)
- Revisions:
- Spevigo
- Tyenne
- Xeljanz
- Revisions:
- Eohilia (PDF)
- New criteria
- Zurzuvae (PDF)
- New criteria
Approved as presented
- Calcitonin Gene-Related Peptide (CGRP) Prophylaxis (PDF)
- Revision
- Cytokine and CAM Antagonists (PDF)
- Revisions:
- Spevigo
- Tyenne
- Xeljanz
- Revisions:
- Eohilia (PDF)
- New criteria
- Zurzuvae (PDF)
- 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 July and October 2024 board meetings into the January 2025 PDL.
MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The July 2024 PDL recommendations are available. Notable changes include:
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Antihistamines, minimally sedating | Loratadine capsule OTC (oral) | Not Reviewed | Preferred |
| Antipsychotics | Chlorpromazine vial (injection) | Not Reviewed | Non-Preferred |
| Calcium Channel Blockers | Nifedipine capsule (oral) | Non-Preferred | Preferred |
| Calcium Channel Blockers | Norvasc tablet (oral) | Non-Preferred | Preferred |
| Calcium Channel Blockers | Taztia XT capsule extended release 24 Hour (oral) | Preferred | Non-Preferred |
| Calcium Channel Blockers | Tiadylt ER capsule extended release 24 Hour (oral) | Preferred | Non-Preferred |
| Calcium Channel Blockers | Tiazac capsule extended release 24 Hour (Ooral) | Non-Preferred | Non-Preferred |
| Glucocorticoids, Inhaled | Fluticasone Propionate (AG) (inhalation) | Not Reviewed | Non-Preferred |
| Glucocorticoids, Inhaled | Qvar Redihaler (inhalation) | Non-Preferred | Preferred |
| Glucocorticoids, Oral | Agamree suspension (oral) | Not Reviewed | Non-Preferred |
| Glucocorticoids, Oral | Eohilia (oral) | Not Reviewed | Preferred |
| NSAIDs | Celebrex capsule (oral) | Non-Preferred | Preferred |
| NSAIDs | Naprosyn suspension (oral) | Not Reviewed | Non-Preferred |
| `Ophthalmic, Anti-Inflammatories | Lotemax Gel (Ophthalmic) | Non-Preferred | Preferred |
| Colony Stimulating Factors | Udenyca Onbody (subcutaneous) | Not Reviewed | Non-Preferred |
| Cytokine & CAM Antagonist | Simlandi (subcutaneous) | Not Reviewed | Non-Preferred |
| Cytokine & CAM Antagonist | Spevigo (subcutaneous) | Not Reviewed | Non-Preferred |
| Cytokine & CAM Antagonist | Tyenne (subcutaneous) | Not Reviewed | Non-Preferred |
| PAH Agents, oral and inhaled | Opsynvi (oral) | Not Reviewed | Non-Preferred |
Retrospective Drug Utilization 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 to improve prescribing or dispensing practices.
The DUR Board reviews and recommends interventions for traditional Medicaid claims. HHSC performs several interventions each calendar year. MCOs are required to create and perform interventions and education for their population.
Presented
- Concurrent Use of Benzodiazepines and/or Sedative-Hypnotic Agents (PDF)
- Monitoring Antipsychotic Induced Metabolic Syndrome (PDF)
- Psychotropic Therapy During Pregnancy (PDF)
- Risks of Long-Term Proton Pump Inhibitor (PPI) Use (PDF)
- Use of Benzodiazepines in Patients with Chronic Obstructive Pulmonary Disease (COPD) (PDF)
Approved as presented
- Concurrent Use of Benzodiazepines and/or Sedative-Hypnotic Agents
- Monitoring Antipsychotic Induced Metabolic Syndrome
- Psychotropic Therapy During Pregnancy
- Risks of Long-Term Proton Pump Inhibitor (PPI) Use
- Use of Benzodiazepines in Patients with Chronic Obstructive Pulmonary Disease (COPD)
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.