The Texas Drug Utilization Review (DUR) Board met on January 22, 2021, to make recommendations for Medicaid clinical prior authorizations and the Preferred Drug List (PDL). A summary of this meeting is now available from the Texas Vendor Drug Program (VDP) website.
Clinical Prior Authorization Reminders
The following are reminders for clinical prior authorizations:
- 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 VDP.
- Each MCO pharmacy website must include a list of its active clinical prior authorizations.
Preferred Drug List Reminders
The following are reminders for the PDL:
- All PDL recommendations are pending until the HHSC executive commissioner releases the final decision. HHSC will incorporate the approved decisions from the January and April 2021 board meetings into the PDL published in July 2021.
- Prescribing providers must use the Medicaid formulary and preferred drug list.
- MCOs adhere to the Medicaid formulary and PDL. Providers should evaluate a drug’s formulary status before its preferred status.
About the Texas DUR Board
The board meets next on Friday, April 23, 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.