Clinical Criteria
ADD/ADHD Agents (Revised August 15, 2017)*
Alinia (Revised May 27, 2016)*
Aliskiren Containing (Revised May 31, 2016)*
Allergen Extracts (Revised July 31, 2015)*
Altabax (Revised May 27,2016)*
Androgenic Agents (Pending Implementation) (Revised May 8, 2017)*
Antiemetics (Revised May 27, 2016)*
Antipsychotics (Revised May 9, 2018)*
Anxiolytics and Sedatives-Hypnotics (Revised April 27, 2018)*
Buprenorphine Agents (Revised March 26, 2018)*
Byetta (Revised April 3, 2015)*
Carisoprodol Overuse (Pending Implementation)(Revised November 20, 2017)*
Colcrys (Pending Implementation) (Revised May 20, 2016)*
Copaxone (Pending Implementation) (Revised March 19, 2018)*
Cough & Cold (Revised February 12, 2018)*
COX-2 Inhibitors (Revised April 3, 2015)*
Cyclobenzaprine (Revised May 8, 2017)*
Cymbalta (Pending Implementation) (Revised May 8, 2017)*
Cystic Fibrosis Agents (Revised April 27, 2018)*
Cytokine and CAM Antagonists (Revised March 19, 2018)*
Desmopressin (Revised May 8, 2017)*
Dextromethorphan Overutilization (Revised June 6, 2018)*
Diabetic Test Strip (Pending Implementation) (February 3, 2017)*
Diclofenac(Pending Implementation)(Revised August 3, 2017)*
DPP4 Inhibitor (Pending Implementation) (Revised April 3, 2018)*
Drug Regimen Optimization (Revised May 8,2017)*
Dupixent (Revised August 21, 2017)*
Duplicate Therapy (Revised February 1, 2016)*
Emflaza (Revised July 28, 2017)*
Enzymes (Pending Implementation) (Revised March 30, 2018)*
Erythropoiesis-Stimulating Agents (Revised October 3, 2017)*
Fentanyl (Revised May 30, 2017)*
Forteo (Pending Implementation) (Revised, May 8, 2017)*
Fosrenol (Revised January 15, 2016)
Gabapentin Agents (Revised December 12, 2017)*
Gaucher's Disease Agents (Pending Implementation) (Revised July 31, 2015)*
GI Motility Agents (Revised February 12,2018)*
GLP-1 Receptor Agonists (Pending Implementation) (Revised April 6, 2018)*
Growth Hormone Products (Pending Implementation)(Revised May 11, 2017)*
Growth Hormone Products (Revised April 3, 2015)*
Growth Hormone Quick Reference Guide
H.P. Acthar (Revised February 17, 2016)*
HAE Agents (Pending Implementation) (Revised July 31, 2015)*
Imiquimod (Revised May 18, 2018)*
Increlex (Revised May 8,2017)*
Injectable Agents for PAH (Pending Implementation) (Revised July 31, 2015)*
Januvia (Revised April 3, 2015)*
Ketorolac (Revised August 11, 2017)*
Keveyis (Pending Implementation)(Revised November 3, 2017)*
Leukotriene Modifiers (Revised February 1, 2016)*
Lidoderm (Pending Implementation) (Revised February 15, 2018)*
Lovaza (Revised April 3, 2015)*
Lyrica (Pending Implementation)*
Morphine Equivalent Dosing (Revised December 11, 2017)*
Nuedexta (Revised January 27, 2017)*
Nuplazid (Pending Implementation)(Revised July 28, 2017)*
Opiate Overutilization (Revised August 11, 2017)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised December 21, 2016)*
Oxycontin/Narcotic Analgesic (Revised November 20, 2017)*
PCSK9 Inhibitors (Revised November 17, 2016)*
Phosphate Binders (Pending Implementation) (Revised March 26, 2018)*
Plavix (Pending Implementation) (Revised April 12, 2018)*
Promethazine Utilization (Revised February 12, 2018)*
Propylthiouracil (Revised August 11, 2017)*
Proton Pump Inhibitors (Pending Implementation) (Revised January 26, 2018)*
Provigil and Nuvigil (Revised October 5, 2017)*
Ranexa (Revised November 20, 2017)*
Revatio (Revised June 25, 2018)*
Savella (Pending Implementation) (Revised November 30, 2015)*
Symlin (Revised April 12, 2018)*
Synagis (Revised December 11, 2017)*
Thiazolidinediones (Revised February 8,2018)*
Topical Acne Agents (Pending Implementation) (Revised January 4, 2016)*
Topical Immunomodulators (Revised May 31, 2017)*
Topical Retinoids (Pending Implementation) (Revised January 26, 2018)*
Valturna (Revised August 23, 2017)*
Victoza (Revised April 3, 2015)*
VMAT2 Inhibitors (Pending Implementation) (Revised April 10, 2018)*
Xifaxan (Revised April 12, 2018)*
Xyrem (Revised April 12, 2018)*
Zelboraf (Pending Implementation) (Revised April 12, 2018)*
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Announcements
July 2018 DUR Board Meeting Summary
by REBECCA.HOHENSEE on 07/09/2018
Agenda for July Drug Utilization Review Board Meeting Now Available The agenda for the Texas Drug Utilization Review Board meeting on Friday, July 27 is now available. Instructions on how to submit written materials to the board for review prior to the meeting and for presenting during the meeting are available from the Vendor Drug Program website at txvendordrug.com/resources/drug-utilization-review-board.
Semi-annual Medicaid Preferred Drug List Update Coming July 26
by LAUREN.NEWMAN on 06/22/2018
Texas Medicaid will publish the semi-annual update of the Medicaid preferred drug list on July 26. The update is based on changes presented and recommended at recent Texas Drug Utilization Review Board meetings. Visit the Texas Vendor Drug Program website at www.txvendordrug.com/about/current-news for a list of noteworthy changes in the July update.
Symdeko Clinical Prior Authorization Effective July 16 for Traditional Medicaid
by LAUREN.NEWMAN on 06/04/2018
The Vendor Drug Program will implement a clinical prior authorization for Symdeko for people enrolled in traditional Medicaid. The criteria was approved by the Texas Drug Utilization Review Board during its meeting in April, and will go into effect July 16. The prior authorization is optional for people enrolled in Medicaid managed care. To learn more, and review the cystic fibrosis agents prior authorization criteria guide, please visit www.txvendordrug.com/about/current-news.
Anti-psychotics Clinical Prior Authorization Changes Begin July 2 for Traditional Medicaid
by LAUREN.NEWMAN on 06/04/2018
The Vendor Drug Program will revise the anti-psychotics clinical prior authorization for people enrolled in traditional Medicaid beginning July 2. The revision will allow for an initial 90-day grace period for newly-diagnosed patients until his or her diagnosis appears in the pharmacy prior authorization system. The prior authorization is optional for people enrolled in Medicaid managed care. To learn more, and review the criteria guide, please visit www.txvendordrug.com/about/current-news.
Update to Morphine Equivalent Dose Limits for Medicaid Fee-for-Service
by CHRISTINA.FAULKNER on 04/20/2018
Beginning May 30, HHSC will decrease the daily morphine equivalent dose (MED) limit for people enrolled in Medicaid fee-for-service. The new limit will be set at 240 MED, and will be applied to all opioid prescriptions with exceptions for those people diagnosed with cancer or those receiving palliative or hospice care. More information about the MED limits is available at https://www.txvendordrug.com/about/current-news.