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The purpose of this bulletin is to notify providers about routine changes to new drug service authorization (SA) requirements for drugs reviewed clinically and through fiscal analysis by the Drug Utilization Review (DUR) Board in June 2025 and to the Virginia Medicaid Fee-for-Service Preferred Drug List (PDL) program (also known as the Common Core Formulary, or CCF) for drugs reviewed by the Department’s Pharmacy and Therapeutics Committee in October 2025.

The Drug Utilization Review Board is authorized by 12VAC30-130-340 and the Pharmacy and Therapeutics Committee is authorized by 12VAC30-130-1000. The meetings of these committees are open to the public and are posted on the Virginia Town Hall meetings page.  

The PDL/CCF is a list of preferred drugs, by select therapeutic class, for which the Medicaid Fee-for-Service (FFS) program may allow payment without requiring a SA. The PDL/CCF program aims to provide clinically effective and safe drugs for its members in a cost-effective manner. Your continued compliance with and support of this program and its policies are critical to its success.

The PDL/CCF is applicable to the Medicaid and FAMIS Plus FFS populations, and non-dual eligible members covered under the Managed Care Program. The Virginia Medicaid PDL/CCF does not apply to members enrolled in FAMIS or Members with Medicare Part D Plans. 

June 2025 DUR Board Summary

The DUR Board reviewed 8 physician administered drugs - Abecma® (idecabtagene vicleucel), Aucatzyl® (obecabtagene autoleucel), Breyanzi® (lisocabtagene maraleucel), Carvykti® (ciltacabtagene autoleucel), Kymriah® (tisagenlecleucel), Tecartus® (brexucabtagene autoleucel), Tecelra® (afamitresgene autoleucel), and

Yescarta® (axicabtagene ciloleucel). The Board reviewed and approved service authorization criteria for these medications. 

The DUR Board reviewed four pipeline drugs: brensocatib, dordaviprone, rilzabrutinib, and vatiquinone.

The Board reviewed the results of several utilization analyses:

• the impact reports 8 physician administered drugs - Abecma® (idecabtagene vicleucel), Aucatzyl® (obecabtagene autoleucel), Breyanzi® (lisocabtagene maraleucel), Carvykti® (ciltacabtagene autoleucel), Kymriah® (tisagenlecleucel), Tecartus® (brexucabtagene autoleucel), Tecelra® (afamitresgene autoleucel), and Yescarta® (axicabtagene ciloleucel);

• current use of opioids and benzodiazepines;

• concurrent use of opioids and antipsychotics;

• overlaps in opioids, benzodiazepines, and antipsychotics;

• naloxone and buprenorphine utilization for members on opioids;

• Glucagon-Like Peptide-1 Receptor Agonist (GLP-1 RA) utilization 

• ProDUR reports; RetroDUR reports and utilization analysis reports

October 2025 P&T Meeting Summary

On January 1, 2026 the following changes and additions to the Preferred Drug List (PDL) will be effective. 

Virginia Preferred Drug List Changes Effective January 1, 2026
Drug Class	Preferred	Non-Preferred
Cytokine and CAM Antagonists	Adalimumab-ADBM (unbranded version of Cyltezo made by Boehringer   Ingelheim)  Hadlima Pyzchiva	Infliximab Humira
Anticonvulsants		Carbamazepine 200mg chewable tablet Topiramate 50mg sprinkle
Laxatives and Cathartics	Sodium, potassium mag sulfates solution reconstitute authorized generic
Sickle Cell Anemia Treatments	Xromi solution
Ophthalmics, Anti-Allergy		Zaditor OTC Olopatadine drops (Pataday and Patanol)
Ophthalmics, Anti-Inflammatory		fluorometholone
Antibiotics, Vaginal		Nuvessa
Angiotensin Modulators	Telmisartan Telmisartan/HCTZ	Quinapril
Antiemetic/Antivertigo Agents		Metoclopramide syringe
Beta-Blockers	Nebivolol Nadolol
Bronchodilators, Beta Agonist	Albuterol HFA (Proventil)
Intranasal Rhinitis Agents	Fluticasone OTC

Classes in red designate Common Core Formulary “closed classes”