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Summary of April 2024 Drug Utilization Review Board Meeting Now Available

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The Texas Drug Utilization Review (DUR) Board met on Friday, April 26, 2024, to recommend Medicaid clinical prior authorizations and drugs for 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:

Preferred Drug List Reminders

The following are reminders for the PDL:

  • All PDL recommendations are pending until the Texas Health and Human Services Commission (HHSC) executive commissioner releases the final decision. HHSC will incorporate the approved decisions from the January and April 2024 board meetings into the PDL published in July 2024.
  • Prescribing providers must use the Medicaid formulary and preferred drug list.
  • MCOs should adhere to the Medicaid formulary and preferred drug list. Providers should evaluate a drug’s formulary status before its preferred status.

Retrospective DUR Reminders

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.

About the Texas DUR Board

The board’s next meeting is scheduled for Friday, July 26, 2024. 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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