Summary of Oct. 2024 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board met Friday, Oct. 25, 2024, to recommend clinical prior authorizations and drugs on the Texas Medicaid Preferred Drug List. Information now available online includes the following:
- The Oct. 25, 2024, meeting webcast
- Approved minutes from the July 26, 2024, meeting
- A summary of clinical prior authorization, preferred drug list, and retrospective drug utilization recommendations
- The PDL drug class review schedule for the Friday, Jan.31, 2025, 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
- Agamree (PDF)
- New criteria
- Biliary Cholangitis Treatment Agents (PDF)
- New criteria
- Cytokine and CAM Antagonists (PDF)
- New criteria
- Bimzelx
- Omvoh
- New criteria
- Cytokine and CAM Antagonists (PDF)
- Revisions
- Rinvoq LQ (oral)
- Revisions
- Wegovy (PDF)
- New criteria
- Zoryve (PDF)
- New criteria
Approved as presented
- Agamree (PDF)
- New criteria
- Biliary Cholangitis Treatment Agents (PDF)
- New criteria
- Cytokine and CAM Antagonists (PDF)
- New criteria
- Bimzelx
- Omvoh
- New criteria
- Cytokine and CAM Antagonists (PDF)
- Revisions
- Rinvoq LQ (oral)
- Revisions
- Zoryve (PDF)
- New criteria
Approved with recommendations
- Wegovy (PDF)
- New criteria
- Modified step 1 to greater than or equal to 45 years of age
- 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 Oct. 2024 board meetings into the Jan. 2025 PDL.
MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The Oct. 2024 PDL recommendations are available. Notable changes include:
| PDL Class | Drug | Current PDL Status | Recommended Status |
|---|---|---|---|
| Androgenic Agents | Testim Tube (transdermal) | Non-preferred | Preferred |
| Antibiotics, gastrointestinal (GI) | Vancocin HCL (oral) | Non-preferred | Preferred |
| Antibiotics, vaginal | Cleocin cream (vaginal) | Non-preferred | Preferred |
| Antibiotics, vaginal | Clindesse cream (vaginal) | Preferred | Non-preferred |
| Antibiotics, vaginal | Xaciato (vaginal) | Non-preferred | Preferred |
| Anticonvulsants | Libervant film (Buccal) | Not Reviewed | Preferred |
| Antiemetic-antivertigo Agents (excludes injectables) | Antivert tablet (oral) | Non-preferred | Preferred |
| Antiemetic-antivertigo Agents (excludes injectables) | Bonjesta (oral) | Non-preferred | Preferred |
| Antiemetic-antivertigo Agents (excludes injectables) | Marinol (oral) | Non-preferred | Preferred |
| Antiemetic-antivertigo Agents (excludes injectables) | Ondansetron ODT 16 mg (oral) | Not Reviewed | Non-preferred |
| Antifungals, oral | Sporanox capsule (oral) | Non-preferred | Preferred |
| Antifungals, topical | Jublia (topical) | Non-preferred | Preferred |
| Antifungals, topical | Tripenicol cream (topical) | Not Reviewed | Non-preferred |
| Antifungals, topical | Tripenicol solution (topical) | Not Reviewed | Non-preferred |
| Antivirals, topical | Xerese (topical) | Non-preferred | Preferred |
| GI Motility, chronic | Lotronex (oral) | Non-preferred | Preferred |
| GI Motility, chronic | Trulance (oral) | Non-preferred | Preferred |
| Growth Hormone | Sogroya (subcutaneous) | Non-preferred | Preferred |
| Hypoglycemics, incretin mimetics/enhancers | Sitagliptin Tablet (AG Zituvio) (oral) | Not Reviewed | Non-preferred |
| Hypoglycemics, incretin mimetics/enhancers | Sitagliptin/Metformin yablet (oral) | Not Reviewed | Non-preferred |
| Hypoglycemics, incretin mimetics/enhancers | Zituvio tablet (oral) | Not Reviewed | Non-preferred |
| Hypoglycemics, insulin and related | Fiasp Flextouch pen (subcutaneous) | Non-preferred | Preferred |
| Hypoglycemics, insulin and related | Fiasp Penfill (subcutaneous) | Non-preferred | Preferred |
| Hypoglycemics, insulin and related | Fiasp Pumpcart (subcutaneous) | Non-preferred | Preferred |
| Hypoglycemics, insulin and related | Fiasp vial (subcutaneous) | Non-preferred | Preferred |
| Hypoglycemics, insulin and related | Levemir flexpen (subcutaneous) | Preferred | Non-preferred |
| Hypoglycemics, insulin and related | Levemir flextouch (subcutaneous) | Preferred | Non-preferred |
| Hypoglycemics, insulin and related | Levemir vial (subcutaneous) | Preferred | Non-preferred |
| Hypoglycemics, insulin and related | Novolin N flexpen (subcutaneous) | Non-preferred | Preferred |
| Opiate Dependence Treatments | Rextovy Spray (nasal) | Not Reviewed | Preferred |
Single New Drug Review
| PDL Class | Drug | Current DL Status | Recommended Status |
|---|---|---|---|
| Cytokine and Cam Antagonists | Adalimumab-Adbm 100mg/Ml Syringe Kit (subcutaneous) | Not reviewed | Not preferred |
| Cytokine and Cam Antagonists | Adalimumab-Adbm 100mg/Ml Pen Kit (subcutaneous) | Not reviewed | Not preferred |
| Immunomodulators, Atopic Dermatitis | Adbry Autoinjector (subcutaneous) | Not reviewed | Not preferred |
| Cytokine and Cam Antagonists | Cyltezo 100mg/Ml Syringe Kit (subcutaneous) | Not reviewed | Not preferred |
| Cytokine and Cam Antagonists | Cyltezo 100mg/Ml Pen Kit (subcutaneous) | Not reviewed | Not preferred |
| Angiotensin Modulators | Entresto Sprinkle Capsule (oral) | Not reviewed | Not preferred |
| Movement Disorders | Ingrezza Sprinkle Capsule (oral) | Not reviewed | Preferred |
| Bile Salts | Iqirvo tablet (oral) | Not reviewed | Not preferred |
| Immunosuppressives, Oral/SQ | Myhibbin suspension (oral) | Not reviewed | Not preferred |
| Oncology, Oral – Other | Ojemda suspension (oral) | Not reviewed | Preferred |
| Oncology, Oral - Other | Ojemda tablet (oral) | Not reviewed | Preferred |
| Cytokine and Cam Antagonists | Omvoh PFS (subcutaneous) | Not reviewed | Not preferred |
| Cytokine and Cam Antagonists | Rinvoq LQ Solution (oral) | Not reviewed | Not preferred |
| Immunomodulators, Asthma | Xolair Autoinjector (subcutaneous) | Not reviewed | Preferred |
| Immunomodulators, Atopic Dermatitis | Zoryve 0.15% cream (topical) | Not reviewed | Not preferred |
| Immunomodulators, Atopic Dermatitis | Zoryve 0.3% cream (topical) | Not reviewed | Not preferred |
| Immunomodulators, Atopic Dermatitis | Zoryve 0.3% foam (topical) | Not reviewed | Not 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
- Appropriate Treatment of Selected Diabetes Comorbidities in Adults (PDF)
- Drug Abuse Risk Mitigation (PDF)
- Non-Adherence to Antiepileptic Therapies (PDF)
- Under-Treatment of Chronic Hepatitis C Virus Infections (PDF)
Approved as presented
- Appropriate Treatment of Selected Diabetes Comorbidities in Adults
- Drug Abuse Risk Mitigation
- Non-Adherence to Antiepileptic Therapies
- Under-Treatment of Chronic Hepatitis C Virus Infections
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.