Summary of Oct. 2024 Drug Utilization Review Board Meeting Now Available

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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

Approved as presented

Approved with recommendations

  • Wegovy (PDF)
    • New criteria
      • Modified step 1 to greater than or equal to 45 years of age

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 ClassDrugCurrent PDL StatusRecommended Status
Androgenic AgentsTestim Tube (transdermal)Non-preferredPreferred
Antibiotics, gastrointestinal (GI)Vancocin HCL (oral)Non-preferredPreferred
Antibiotics, vaginalCleocin cream (vaginal)Non-preferredPreferred
Antibiotics, vaginal
 
Clindesse cream (vaginal)PreferredNon-preferred
Antibiotics, vaginalXaciato (vaginal)Non-preferredPreferred
AnticonvulsantsLibervant film (Buccal)Not ReviewedPreferred
Antiemetic-antivertigo Agents (excludes injectables)Antivert tablet (oral)Non-preferredPreferred
Antiemetic-antivertigo Agents (excludes injectables)Bonjesta (oral)Non-preferredPreferred
Antiemetic-antivertigo Agents (excludes injectables)Marinol (oral)Non-preferredPreferred
Antiemetic-antivertigo Agents (excludes injectables)Ondansetron ODT 16 mg (oral)Not ReviewedNon-preferred
Antifungals, oralSporanox capsule (oral)Non-preferredPreferred
Antifungals, topicalJublia (topical)Non-preferredPreferred
Antifungals, topicalTripenicol cream (topical)Not ReviewedNon-preferred
Antifungals, topicalTripenicol solution (topical)Not ReviewedNon-preferred
Antivirals, topicalXerese (topical)Non-preferredPreferred
GI Motility, chronicLotronex (oral)Non-preferredPreferred
GI Motility, chronicTrulance (oral)Non-preferredPreferred
Growth HormoneSogroya (subcutaneous)Non-preferredPreferred
Hypoglycemics, incretin mimetics/enhancersSitagliptin Tablet (AG Zituvio) (oral)Not ReviewedNon-preferred
Hypoglycemics, incretin mimetics/enhancersSitagliptin/Metformin yablet (oral)Not ReviewedNon-preferred
Hypoglycemics, incretin mimetics/enhancersZituvio tablet (oral)Not ReviewedNon-preferred
Hypoglycemics, insulin and relatedFiasp Flextouch pen (subcutaneous)Non-preferredPreferred
Hypoglycemics, insulin and relatedFiasp Penfill (subcutaneous)Non-preferredPreferred
Hypoglycemics, insulin and relatedFiasp Pumpcart (subcutaneous)Non-preferredPreferred
Hypoglycemics, insulin and relatedFiasp vial (subcutaneous)Non-preferredPreferred
Hypoglycemics, insulin and relatedLevemir flexpen (subcutaneous)PreferredNon-preferred
Hypoglycemics, insulin and relatedLevemir flextouch (subcutaneous)PreferredNon-preferred
Hypoglycemics, insulin and relatedLevemir vial (subcutaneous)PreferredNon-preferred
Hypoglycemics, insulin and relatedNovolin N flexpen (subcutaneous)Non-preferredPreferred
Opiate Dependence TreatmentsRextovy Spray (nasal)Not ReviewedPreferred

Single New Drug Review

PDL ClassDrugCurrent DL StatusRecommended Status
Cytokine and Cam AntagonistsAdalimumab-Adbm 100mg/Ml Syringe Kit (subcutaneous)Not reviewedNot preferred
Cytokine and Cam AntagonistsAdalimumab-Adbm 100mg/Ml Pen Kit (subcutaneous)Not reviewedNot preferred
Immunomodulators, Atopic DermatitisAdbry Autoinjector (subcutaneous)Not reviewedNot preferred
Cytokine and Cam AntagonistsCyltezo 100mg/Ml Syringe Kit (subcutaneous)Not reviewedNot preferred
Cytokine and Cam AntagonistsCyltezo 100mg/Ml Pen Kit (subcutaneous)Not reviewedNot preferred
Angiotensin ModulatorsEntresto Sprinkle Capsule (oral)Not reviewedNot preferred
Movement DisordersIngrezza Sprinkle Capsule (oral)Not reviewedPreferred
Bile SaltsIqirvo tablet (oral)Not reviewedNot preferred
Immunosuppressives, Oral/SQMyhibbin suspension (oral)Not reviewedNot preferred
Oncology, Oral – OtherOjemda suspension (oral)Not reviewedPreferred
Oncology, Oral - OtherOjemda tablet (oral)Not reviewedPreferred
Cytokine and Cam AntagonistsOmvoh PFS (subcutaneous)Not reviewedNot preferred
Cytokine and Cam AntagonistsRinvoq LQ Solution (oral)Not reviewedNot preferred
Immunomodulators, AsthmaXolair Autoinjector (subcutaneous)Not reviewedPreferred
Immunomodulators, Atopic DermatitisZoryve 0.15% cream (topical)Not reviewedNot preferred
Immunomodulators, Atopic DermatitisZoryve 0.3% cream (topical)Not reviewedNot preferred
Immunomodulators, Atopic DermatitisZoryve 0.3% foam (topical)Not reviewedNot 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

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.