Summary of Jan. 2025 Drug Utilization Review Board Meeting Now Available
The Texas Drug Utilization Review Board met Friday, Jan. 31, 2025, to recommend clinical prior authorizations and drugs on the Texas Medicaid Preferred Drug List. Information now available includes the following:
- The Jan. 31, 2025, meeting webcast
- Approved minutes from the Oct. 25, 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, April 25, 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.
Antipsychotics
- Cobenfy – New criteria
- Criteria presented (PDF)
- Board review status:
- Approved as presented
- Approved criteria (PDF)
Erythropoiesis-Stimulating Agents
- Vafseo – New criteria
- Criteria presented (PDF)
- Board review status:
- Approved as presented
- Approved criteria (PDF)
Monoclonal Antibody Agents
- Ebglyss – New criteria
- Criteria presented (PDF)
- Board review status:
- Approved as presented
- Approved criteria (PDF)
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 January and July 2025 board meetings into the July 2025 PDL.
MCOs have the same non-preferred prior authorization criteria requirements from following the Texas formulary and PDL.
The Jan. 2025 PDL recommendations are available. Notable changes include:
| PDL Class | Drug | Current PDL status | Recommended PDL status |
|---|---|---|---|
| Acne Agents, Topical | Epiduo Forte (Topical) Gel W/Pump | Preferred | Non-Preferred |
| Analgesics, narcotic – short acting | Tramadol 25mg (oral) tablet | Not- reviewed | Non-preferred |
| Analgesics, narcotic – short acting | Tramadol 75mg (oral) tablet | Not- reviewed | Non-preferred |
| Antihypertensives, sympatholytics | Catapres-TTS (transderm) patch | Preferred | Non-preferred |
| Antimigraine Agents, other | Qulipta (oral) tablet | Non-preferred | Preferred |
| Antiparkinson’s Agents (oral/transdermal) | Crexont (oral) cap IR ER | Not- reviewed | Non-preferred |
| Intranasal Rhinitis Agents | Dymista (nasal) spray/pump | Non-preferred | Preferred |
| Glucagon Agents | Gvoke (subcut) vial | Non-preferred | Preferred |
| Glucagon Agents | Gvoke Hypopen subcut) Auto Injct | Non-preferred | Preferred |
| Glucagon Agents | Gvoke PFS (subcut) syringe | Non-preferred | Preferred |
| Intranasal Rhinitis Agents | Omnaris (nasal) spray/pump | Non-preferred | Preferred |
| Intranasal Rhinitis Agents | Qnasl (nasal) HFA AER AD | Non-preferred | Preferred |
| Intranasal Rhinitis Agents | Triamcinolone acetonide (nasal) spray | Non-preferred | Preferred |
| Movement Disorders | Xenazine (oral) tablet | Non-preferred | Preferred |
| Neuropathic Pain | Gralise (oral) tab ER 24h | Non-preferred | Preferred |
| Neuropathic Pain | Horizant (oral) tablet ER | Non-preferred | Preferred |
| Neuropathic Pain | Lyrica (oral) solution | Non-preferred | Preferred |
| Neuropathic Pain | Lyrica CR (oral) tab ER 24h | Non-preferred | Preferred |
| Neuropathic Pain | Neurontin (oral) capsule | Non-preferred | Preferred |
| Neuropathic Pain | Neurontin (oral) solution | Non-preferred | Preferred |
| Neuropathic Pain | Neurontin (oral) tablet | Non-preferred | Preferred |
| Neuropathic Pain | Savella (oral) tab DS PK | Non-preferred | Preferred |
| Neuropathic Pain | Savella (oral) tablet | Non-preferred | Preferred |
| Oncology, oral – lung | Lazcluze (oral) tablet | Not- reviewed | Preferred |
| Oncology, oral – lung | Retevmo (oral) tablet | Not- reviewed | Preferred |
| Proton Pump Inhibitors (Oral) | Dexilant (oral) cap DR BP | Preferred | Non-preferred |
| Stimulants And Related Agents | Onyda xr (oral) sus ER 24H | Not- reviewed | Non-preferred |
Single new drug review
| Preferred class | Drug | Current status | Recommended status |
|---|---|---|---|
| Cytokine & CAM Antagonists | Adalimumab-ryvk (cf) syringe (subcutaneous) | Not- Reviewed | Non-preferred |
| Cytokine & CAM Antagonists | Cimzia syringe kit (subcutaneous) | Not- Reviewed | Non-preferred |
| Antipsychotics | Cobenfy capsule (oral) | Not- Reviewed | Non-preferred |
| Antipsychotics | Cobenfy capsule, starter pack (oral) | Not- Reviewed | Non-preferred |
| Immunomodulators, Atopic Dermatitis | Ebglyss pen (subcutaneous) | Not- Reviewed | Non-preferred |
| Cytokine & CAM Antagonists | Idacio (CF) pen (subcutaneous) | Not- Reviewed | Non-preferred |
| Bile Salts | Livdelzi capsule (oral) | Not- Reviewed | Non-preferred |
| COPD Agents | Ohtuvayre (inhalation) | Not- Reviewed | Non-preferred |
| Cytokine & CAM Antagonists | Tremfya pen (subcutaneous) | Not- Reviewed | Non-preferred |
| Erythropoiesis Stimulating Proteins | Vafseo tablet (oral) | Not- Reviewed | Non-preferred |
| Anticonvulsants | Vigafyde solution (oral) | Not- Reviewed | 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.
Congestive Heart Failure without Guideline-Directed Medication Therapy
- Criteria presented (PDF)
- Board review status:
- Approved as presented
Chronic Opioid Use without Naloxone Therapy
- Criteria presented (PDF)
- Board review status:
- Approved with recommendations
- Recommendation:
- Approved with additional wording in provider letter that naloxone is covered on formulary with no additional cost to the member
Duplicative Antidiabetic Therapies
- Criteria presented (PDF)
- Board review status:
- Approved as presented
Psychiatric Therapies with Conflicting Mechanisms of Action
- Criteria presented (PDF)
- Board review status:
- Approved with recommendations
- Recommendation:
- Approved with the change of targeted benzodiazepines to only include those that are high risk for misuse
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.