Information posted June 19, 2020
The Texas Drug Utilization Review (DUR) Board met May 22, 2020, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available from the Texas Vendor Drug Program (VDP) website.
Clinical Prior Authorization Reminders
- Clinical prior authorizations for traditional Medicaid and Medicaid managed care organizations (MCOs) may differ. The Pharmacy Clinical Prior Authorization Assistance Chart identifies each MCO’s prior authorizations and how they relate to the prior authorizations for traditional Medicaid.
- Each MCO pharmacy website must include a list of the clinical prior authorizations that are active for that MCO.
Preferred Drug List Reminders
- All Preferred Drug List (PDL) recommendations are pending until the final decision is released by the Health and Human Services Commission (HHSC) executive commissioner. HHSC-approved decisions from the January and May 2020 board meetings will be incorporated into the PDL published in July 2020.
- Prescribing providers must use the Medicaid formulary and the PDL.
- MCOs adhere to the Medicaid formulary and the PDL and should evaluate the drugs’ formulary status before checking the preferred status.
About the Texas DUR Board
The next board meeting is scheduled for Friday, July 24, 2020. Board members meet quarterly in Austin to recommend outpatient prescription drugs in the Medicaid program. The schedule of upcoming meetings, instructions on how to submit written materials to the board, and directions about publicly testifying before the board are available on the VDP website.