The Texas Drug Utilization Review (DUR) Board met on October 22 and 23, 2020, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list (PDL). A summary of these meetings is now available on 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 which MCO utilizes each prior authorization and how those prior authorizations relate to those used by the VDP.
Each MCO pharmacy website must include a list of its active clinical prior authorizations.
Preferred Drug List Reminders
All PDL recommendations are pending until the HHSC executive commissioner releases the final decision. The Health and Human Services Comission will incorporate the approved decisions from the July and October 2020 board meetings into the PDL published in January 2021.
Prescribing providers must use the Medicaid formulary and preferred drug list.
MCOs adhere to the Medicaid formulary and preferred drug list. Providers should evaluate a drug’s formulary status before it’s preferred status.
About the Texas DUR Board
The board next meets on Friday, January 22, 2021. Board members meet quarterly in Austin to recommend 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 in front of the board are available on the VDP website.