On Friday, July 21, 2023, the Texas Drug Utilization Review (DUR) Board met to recommend Medicaid clinical prior authorizations. A summary of this meeting is now available from the Texas Health and Human Services Commission (HHSC) Vendor Drug Program (VDP) website.
Clinical Prior Authorization Reminders
The following reminders concern 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 uses each prior authorization and how these prior authorizations relate to those used by VDP.
- Each MCO pharmacy website must include a list of its active clinical prior authorizations. Refer to the MCO Search to find each MCO’s list of clinical prior authorizations.
Preferred Drug List Reminders
The following reminders concern the preferred drug list (PDL):
- The board did not review the PDL at this meeting. HHSC will incorporate the approved decisions from October 2023 board meetings into the January 2024 PDL.
- Prescribing providers must use the Medicaid formulary and PDL.
- MCOs must 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’s next meeting is scheduled for Thursday, October 12, 2023, to review the July and October PDL drug classes. 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.
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