Clinical Criteria
ADD/ADHD Agents (Revised February 10, 2020)*
Alinia (Revised March 21, 2019)*
Aliskiren Containing Agents (Revised March 21, 2019)*
Allergen Extracts (Revised December 10, 2019)*
Altabax (Revised March 21, 2019)*
Androgenic Agents (Pending Implementation) (Revised March 21, 2019)*
Antiemetic Agents (Revised March 21, 2019)*
Antipsychotic Agents (Revised July 15, 2020)*
Anxiolytics and Sedative-Hypnotics (Pending Implementation) (Revised February 18, 2020)*
Anxiolytics and Sedative-Hypnotics (Revised March 22, 2019)*
Arikayce (Pending Implementation) (Revised April 26, 2019)*
Buprenorphine Agents (Revised March 22, 2019)*
Carisoprodol Overuse (Revised March 26, 2019)*
Carisoprodol-Containing Agents (Pending Implementation) (Revised May 23, 2019)*
CGRP Antagonists (Pending Implementation) (Revised August 29, 2019)*
CNS Stimulants (Revised October 29, 2019)*
Colcrys (Pending Implementation) (Revised March 26, 2019)*
Cough & Cold Agents (Revised March 10, 2020)*
COX-2 Inhibitors (Revised January 30, 2020)*
Cyclobenzaprine (Revised March 27, 2019)*
Cymbalta (Pending Implementation) (Revised January 30, 2020)*
Cystic Fibrosis Agents (Revised January 30, 2020)*
Cytokine and CAM Antagonists (Pending Implementation (Revised August 27, 2020)*
Cytokine and CAM Antagonists (Revised November 7, 2019)*
Desmopressin (Revised March 27, 2019)*
Dextromethorphan Overutilization (Revised December 30, 2019)*
Diabetic Test Strips (Pending Implementation) (Revised March 27, 2019)*
Diacomit (Pending Implementation) (Revised August 20, 2020)*
Diclofenac (Pending Implementation) (Revised March 27, 2019)*
Doxylamine/Pyridoxine (Pending Implementation) (Revised October 29, 2019)*
DPP4 Inhibitors (Revised March 27, 2019)*
Drug Regimen Optimization (Pending Implementation) (Revised November 11, 2019)*
Drug Regimen Optimization (Revised September 16, 2019)*
Dupixent (Revised June 17, 2020)*
Duplicate Therapy (Revised July 15, 2020)*
Emflaza (Revised July 3, 2019)*
Enzymes (Revised September 11, 2019)*
Epidiolex (Pending Implementation) (Revised August 20, 2020)*
Erythropoiesis-Stimulating Agents (Revised March 28, 2019)*
Fentanyl Agents (Revised March 28, 2019)*
Forteo (Pending Implementation) (Revised March 28, 2019)*
Gabapentin Agents (Revised March 29, 2019)*
Gaucher's Disease Agents (Pending Implementation) (Revised July 15, 2019)*
GI Motility Agents (Pending Implementation) (Revised July 30, 2019)*
GI Motility Agents (Revised March 29, 2019)*
Glatiramer Acetate Injection (Pending Implementation) (Revised July 15, 2019)*
GLP-1 Receptor Agonists (Revised July 15, 2020)*
Growth Hormone Agents (Revised February 20, 2020)*
Growth Hormone Quick Reference Guide
HAE Agents (Pending Implementation) (Revised July 15, 2019)*
HP Acthar (Pending Implementation) (Revised July 24, 2020)*
HP Acthar (Revised July 15, 2019)*
Imiquimod (Revised March 29, 2019)*
Increlex (Revised March 29, 2019)*
Inhaled Antibiotics (Pending Implementation) (Revised February 13, 2020)*
Ketorolac (Revised March 29, 2019)*
Keveyis (Pending Implementation) (Revised March 29, 2019)*
Leukotriene Modifiers (Revised July 15, 2019)*
Lidocaine Patches (Pending Implementation) (Revised July 15, 2019)*
Lovaza (Revised March 29, 2019)*
Lyrica (Pending Implementation) (Revised June 26, 2020)*
Makena (Revised May 14, 2019)*
Monoclonal Antibody Agents for Asthma (Pending Implementation) (Revised May 26, 2020)
Nuedexta (Revised March 29, 2019)*
Nuplazid (Pending Implementation) (Revised March 29, 2019)*
Ophthalmic Immunomodulators (Pending Implementation) (Revised June 30, 2020)*
Opiate Overutilization (Pending Implementation September 1, 2020) (Revised July 27, 2020)*
Opiate Overutilization (Revised January 30, 2020)*
Opiate/Benzodiazepine/Muscle Relaxant Combinations (Revised January 30, 2020)*
Opioid Policy Criteria (Formerly MME criteria) (Revised July 20, 2020)*
Orilissa (Pending Implementation) (Revised March 29, 2019)*
Oxervate (Pending Implementation) (Revised July 24, 2020)*
Oxycontin / Narcotic Analgesic (Revised March 29, 2019)*
Palforzia (Pending Implementation) (Revised August 24, 2020)*
PCSK9 Inhibitors (Pending Implementation) (Revised April 6, 2020)*
PCSK9 Inhibitors (Revised March 29, 2019)*
PDE5-Inhibitors (Revised November 8, 2019)*
Phosphate Binders (Revised January 30, 2020)*
Plavix (Pending Implementation) (Revised March 29, 2019)*
Promethazine Utilization (Revised March 29, 2019)*
Propylthiouracil (Revised March 29, 2019)*
Proton Pump Inhibitors (Pending Implementation) (Revised March 29, 2019)*
Pulmonary Hypertension Agents (Pending Implementation) (Revised February 13, 2020)*
Ranexa (Revised March 29, 2019)*
Retinoids (Pending Implementation) (Revised July 15, 2020)*
Savella (Pending Implementation) (Revised March 29, 2019)*
SGLT2 Agents (Pending Implementation) (Revised May 1, 2019)
Sickle Cell Agents (Revised January 30, 2020)*
Symlin (Revised March 29, 2019)*
Synagis (Revised August 11, 2020)*
Thiazolidinediones (Revised March 29, 2019)*
Topical Acne Agents (Pending Implementation) (Revised March 29, 2019)*
Topical Immunomodulators (Revised June 24, 2020)*
Transthyretin Agents (Pending Implementation) (Revised April 24, 2020)
Urea Cycle Disorder Agents (Pending Implementation) (Revised April 26, 2019)
Valturna (Retired) (Revised August 23, 2017)*
VMAT2 Inhibitors (Revised January 30, 2020)*
VMAT2 Inhibitors (Revised June 24, 2020) (Pending Implementation September 21, 2020)*
Xifaxan (Revised March 29, 2019)*
Xyrem (Revised March 29, 2019)*
Zelboraf (Pending Implementation) (Revised March 29, 2019)*
1 - 101
Announcements
Branded Concerta Tablets Return to Non-Preferred Status on Oct. 16
by TANNER.BAIN on 09/18/2020
VDP temporarily removed the non-preferred status for brand Concerta products in the Stimulants drug class on April 23 in response to reported drug shortages. VDP will reverse this change in status on Oct. 16 because of sufficient product availability. A list of affected NDCs is available from the VDP website. To learn more, visit txvendordrug.com/about/news.
Make Plans for Two-day October DUR Board Meeting
by CHRISTINA.FAULKNER on 09/15/2020
The Texas Drug Utilization Review (DUR) Board scheduled for Oct. will take place over two days. Thursday, Oct. 22 has been scheduled to allow sufficient time for public testimony regarding the new drug classes: anticonvulsants, antihemophilic, antineoplastic (i.e., anti-cancer), antiretroviral (i.e., anti-HIV), and medications used to treat multiple sclerosis. These drug classes are not currently reviewed on the Texas Medicaid Preferred Drug List. All medications within these newly-reviewed drug classes will be preferred and continue to be available without PDL prior authorization. The second day of the meeting will be Friday, Oct. 23. To learn more, visit txvendordrug.com/about/news.
Epidiolex and Diacomit Clinical Prior Authorization Criteria Updates
by TANNER.BAIN on 09/09/2020
VDP regularly updates the clinical prior authorization criteria. These updates are necessary to help align VDP drug policies and prior authorization approval criteria with the latest information available on drug information packets, the federal or state regulations. On Oct. 1, 2020, ICD-10 code G40.83 becomes available for Dravet Syndrome. Also, on July 31, 2020, the FDA approved Epidiolex for the treatment of seizures associated with tuberous sclerosis complex in patients one year of age and older. Updates to clinical prior authorization criteria documents were made to reflect these changes. To learn more, visit txvendordrug.com/about/news.
Opioid-Related Clinical Prior Authorization Criteria Updates for Sept. 1
by TANNER.BAIN on 08/17/2020
VDP will revise the "Opioid Policy criteria" and "Opiate Over-utilization criteria" on Sept. 1, 2020, to align with the HHSC uniform opioid policy. To learn more, visit txvendordrug.com/about/news.
Inhaled Glucocorticoid Products Return to Non-Preferred Status on Sept. 18
by CHRISTINA.FAULKNER on 08/25/2020
VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for products in the "Glucocorticoids, Inhaled" drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning Sept. 18, the Medicaid formulary will reflect the PDL status changes for all non-preferred inhaled glucocorticoid products. A list of affected NDCs and preferred PDL drugs is available from the VDP website. To learn more, visit txvendrodrug.com/about/news.
Insulin Products Return to Non-Preferred Status on Sept. 18
by CHRISTINA.FAULKNER on 08/25/2020
VDP temporarily removed the non-preferred status on April 1 in response to reported drug shortages for insulin products in the "Hypoglycemics, Insulins" drug class. VDP will reverse this change in status because of sufficient availability in the market. Beginning Sept. 18, the Medicaid formulary will reflect the PDL status changes for all non-preferred insulin products. A list of affected NDCs and preferred PDL drugs are available from the VDP website. To learn more, visit txvendordrug.com/about/news.
July 2020 Drug Utilization Review Board Meeting Summary
by TANNER.BAIN on 08/11/2020
The Texas Drug Utilization Review Board met July 24, to make recommendations for Medicaid clinical prior authorizations and the preferred drug list. A summary of this meeting is now available from the Texas Vendor Drug Program website at txvendordrug.com/news. The next meeting is scheduled for Friday, Oct. 23.
Status of Generic Albuterol Products Return to Non-preferred Aug. 28
by TANNER.BAIN on 08/04/2020
In response to reported drug shortages for albuterol products in the Bronchodilators, Short-Acting Beta Agonist Inhalers drug class, Texas HHS temporarily removed the non-preferred status from the generic formulations on March 20. We will reverse this change in status because we determined sufficient availability in the market. We made this determination after verifying the current availability of the preferred products ProAir and Proventil, as well as generic albuterol products through multiple sources such as ASHP, FDA, manufacturers, wholesalers, and pharmacies in various regions around Texas. To learn more, visit txvendordrug.com/about/news.
Change to Macrolide Preferred Drug List Prior Authorization Duration Set for Sept. 15
by TANNER.BAIN on 07/22/2020
On Sept 15, 2020, VDP will extend the non-preferred prior authorization duration for macrolides from 30 days to 90 days for people with a diagnosis of Gastroparesis, Cerebral Palsy Gastroparesis, or GERD Gastrostomy complications. This will accommodate longer-term prescribing for such conditions. MCOs are required to comply with this PDL prior authorization criteria, including duration. To learn more, visit txvendordrug.com/about/news.
May 2020 Preferred Drug List Decisions Now Available
by TANNER.BAIN on 07/12/2020
The Texas Drug Utilization Review Board met Friday, May 22 to make recommendations about drugs to be included on the Medicaid preferred drug list. The approved list of decisions is now available. Decisions from both the Jan. and May 2020 board meetings will be incorporated into the July 30, 2020, release of the preferred drug list. To learn more, visit txvendordrug.com/about/news.
Clinical Prior Authorization Update for Topical Immunomodulators Scheduled for Aug. 24
by TANNER.BAIN on 07/06/2020
VDP routinely updates existing clinical prior authorization criteria to reflect recent FDA-approved indications or safety information from the product package insert, and will revise the Eucrisa (crisaborole) criteria within the Topical Immunomodulators clinical prior authorization on Aug. 24, 2020. This prior authorization is optional for Medicaid managed care. To learn more, visit txvendordrug.com/about/news.
Clinical Prior Authorization Update for VMAT2 Inhibitors Scheduled for Sept. 21
by CHRISTINA.FAULKNER on 07/06/2020
VDP routinely updates existing clinical prior authorization criteria to reflect recent FDA-approved indications or safety information from the product package insert, and will revise the Austedo (deutetrabenazine) criteria within the Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors clinical prior authorization on Sept. 21, 2020. This prior authorization is optional for Medicaid managed care. To learn more, visit txvendordrug.com/about/news.
Clinical Prior Authorization Update for Dupixent Scheduled for Aug. 24
by CHRISTINA.FAULKNER on 07/06/2020
VDP routinely updates existing clinical prior authorization criteria to reflect recent FDA-approved indications or safety information from the product package insert, and will revise the Dupixent (dupilumab) clinical prior authorization on Aug. 24, 2020. This prior authorization is optional for Medicaid managed care. To learn ore, visit txvendordrug.com/about/news.
DUR Board to Review New Drug Classes at Oct. 23 Meeting
by CHRISTINA.FAULKNER on 06/24/2020
The Texas Drug Utilization Review Board will perform a clinical review at their Oct. 23, 2020 meeting of anticonvulsants, antihemophilic, antineoplastic (i.e., anti-cancer), antiretroviral (i.e., anti-HIV) and medications used to treat multiple sclerosis. These are protected drug classes not currently reviewed on the Texas Medicaid Preferred Drug List (PDL). All medications within these newly-reviewed drug classes will be preferred and continue to be available without prior authorization. To learn more, visit txvendordrug.com/about/news.
Semi-annual Medicaid Preferred Drug List Update Available July 30
by TANNER.BAIN on 06/19/2020
Texas Medicaid will publish the semi-annual update of the Medicaid preferred drug list on July 27. The update is based on changes presented and recommended at the Jan. and May 2020 Texas Drug Utilization Review Board meetings. The recent temporary PDL changes addressing reported drug shortages will not impact the July PDL update. The PDL will not revise any drug in the short-acting beta agonists or glucocorticoids-inhaled class, or Concerta or Aggrenox. Drug decisions from the Jan. 24 meeting and recommendations from the May 22 meeting are available on the Vendor Drug Program website, as are summaries of noteworthy changes from each meeting. To learn more, visit txvendordrug.com/about/news.