MO HealthNet is continuing the state specific Preferred Drug List and Clinical Edit processes. The following is a listing of therapeutic classes that have been implemented. Please see the implementation schedule for proposed implementation dates for additional classes.
Table of clinical edit documents listed by issue date and description. The description is linked to the file. All files are in PDF.
| Issue Date |
Pharmacy Clinical Edit and PDL Description |
| Jun 05, 2009 |
15 Day Limitation |
| Apr 16, 2012 |
5-HT1 Agonist (Triptan) Therapy-PDL |
| Jul 27, 2011 |
5HT3 Receptor Antagonists-PDL |
| Apr 16, 2012 |
ACE Inhibitors-PDL |
| Apr 16, 2012 |
ACE Inhibitors/Calcium Channel Blocker Combinations-PDL |
| Mar 24, 2003 |
Actiq Lozenges |
| Aug 5, 2010 |
ADHD Therapy |
| Jul 07, 2003 |
Alinia (Nitazoxanide)/antiparasitic/antimicrobial) |
| Apr 16, 2012 |
Alpha-GlucosidaseInhibitors-PDL |
| Apr 16, 2012 |
Alzheimer’s Agents (Cholinesterase Inhibitors) -PDL |
| Apr 10, 2012 |
Amylin Analogs-PDL |
| Dec 19, 2006 |
Amitiza® |
| Jul 07, 2011 |
Ampyra |
| Jul 20, 2011 |
Androgen Hormone Inhibitor-PDL |
| Apr 16, 2012 |
Angiotensin II Receptor Blocker Diuretic Combinations-PDL |
| Apr 16, 2012 |
Angiotensin II Receptor Blockers-PDL |
| Apr 16, 2012 |
Antihyperuricemic Agents-PDL |
| Oct 21, 2010 |
Atypical Antipsychotics |
| Jul 20, 2011 |
Beta Adrenergic Agents Long Acting - PDL |
| Jul 20, 2011 |
Beta Adrenergic Agents Short Acting - PDL |
| Jul 20, 2011 |
Beta Adrenergic Agents/Nebulized - PDL |
| Apr 10, 2012 |
Beta Adrenergic Blockers- PDL |
| Nov 09, 2006 |
BiDil® Tablets |
| Apr 16, 2012 |
Biguanides-PDL |
| Apr 16, 2012 |
Bile Salts Agents-PDL |
| Apr 16, 2012 |
Bone Deossification Suppression Agents - PDL |
| Jun 10, 2011 |
Botulinum Toxin Type A (Botox) |
| Jul 05, 2011 |
Butorphanol |
| Apr 10, 2012 |
Calcium Channel Blockers (DHP)-PDL |
| Apr 10, 2012 |
Calcium Channel Blockers (nonDHP)-PDL |
| Apr 10, 2012 |
Calcium Channel Blockers/ARBS-PDL |
| Jul 29, 2003 |
Cold Sore Treatment Fiscal Edit |
| Nov 17, 2005 |
Combunox® Tablets |
| Jul 20, 2011 |
COPD Anticholinergics -PDL |
| Apr 10, 2012 |
COX-2 Inhibitors -PDL |
| Apr 16, 2012 |
Cryopyrin-Associated Periodic Syndrome (CAPS) Agents-PDL |
| Apr 16, 2012 |
Direct Renin Inhibitors -PDL |
| Apr 16, 2012 |
Disease-Modifying AntiRheumatic Drug (DMARD) - PDL |
| Nov 13, 2003 |
Dolgic LQ® (Acetaminophen/Butalbital/Caffeine) |
| Apr 10, 2012 |
DPP-IV Inhibitors-PDL |
| Apr 16, 2012 |
Electrolyte Depleters-PDL |
| May 16, 2007 |
Emsam® |
| Jan 19, 2006 |
Equetro® |
| Apr 16, 2012 |
Fibromyalgia Agents |
| Jul 29, 2003 |
Fluconazole (Diflucan) |
| Apr 16, 2012 |
FluoroQuinolones-Oral-PDL |
| Jul 28, 2003 |
Forteo® (teriparatide injection / Parathyroid Hormone) |
| Jul 07, 2003 |
Geodon for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible |
| Apr 10, 2012 |
GLP-1 Receptor Agonists -PDL |
| Jul 13, 2010 |
Growth Hormones-PDL |
| Jul 07, 2003 |
H2 Antagonists |
| Jul 20, 2011 |
Hematopoietic Agents |
| Apr 10, 2012 |
Hepatitis C Therapy-PDL |
| Apr 16, 2012 |
Herpes Antivirals-PDL |
| Jul 20, 2011 |
HMG-Co A reductase inhibitors (statins) -PDL |
| Dec 11, 2003 |
H-Pylori Therapy |
| Jul 07, 2011 |
Human Papillomavirus Vaccines |
| Apr 16, 2012 |
Inhaled Antibiotics-PDL |
| Feb 28, 2011 |
Inhaled Corticosteroids - PDL |
| Jul 20, 2011 |
Insulin Mix-PDL |
| Jul 20, 2011 |
Insulin Rapid Acting-PDL |
| Jul 20, 2011 |
Insulins-PDL |
| Jul 20, 2011 |
Insulins Long Acting-PDL |
| Apr 16, 2012 |
Intranasal Antihistamines-PDL |
| Apr 16, 2012 |
Intranasal Steroids - PDL |
| Apr 16, 2012 |
Intravaginal Antibiotics - PDL |
| Nov 13, 2003 |
Klonopin Wafer® (clonazepam) |
| Nov 07, 2003 |
Lactulose Step Therapy Edit |
| Apr 16, 2012 |
Leukotriene-PDL |
| Jul 20, 2011 |
Low Molecular Weight Anticoagulants |
| Apr 16, 2012 |
Macrolides-PDL |
| Apr 16, 2012 |
Meglintinides - PDL |
| Aug 25, 2010 |
Megestrol Acetate |
| Nov 03, 2004 |
Methadone |
| Apr 16, 2012 |
Multiple Sclerosis Agents-PDL |
| Apr 16, 2012 |
Narcotics, Long Acting - PDL |
| Apr 13, 2012 |
Narcotics, Short Acting |
| Feb 09, 2012 |
Narcotics, Short Acting Combinations |
| Apr 16, 2012 |
Niacin Preparations - PDL |
| Jul 20, 2011 |
Non-Ergot Dopamine Receptor Agonists-PDL |
| Jan 26, 2012 |
Non-Oral Contraceptives Fiscal Edit |
| Apr 16, 2012 |
Non-Sedating Antihistamines-PDL |
| Aug 24, 2010 |
NSAID Step Therapy Edit |
| May 03, 2007 |
Nubain® |
| Apr 10, 2012 |
Onychomycosis Antifungal Agents-PDL |
| Jun 20, 2007 |
Opana® Immediate-Release Tablets |
| Apr 16, 2012 |
Ophthalmic Antihistamines-PDL |
| Apr 16, 2012 |
Ophthalmic Mast Cell Stabilizers-PDL |
| Jul 20, 2011 |
Ophthalmic NSAIDs-PDL |
| Apr 16, 2012 |
Ophthalmic Prostaglandin Agonists PDL |
| Apr 16, 2012 |
Oral AntiDiabetics: Combinations-PDL |
| Apr 16, 2012 |
Otic Quinolones-PDL |
| Jan 31, 2005 |
Oxandrin® |
| Apr 16, 2012 |
Pancreatic Enzyme Agents-PDL |
| Sep 09, 2010 |
Platelet Inhibitor-PDL |
| Sep 26, 2005 |
Prostin VR® Pediatric |
| Apr 10, 2012 |
Proton Pump Inhibitor-PDL |
| Nov 12, 2010 |
Psychotropic Medications Polypharmacy |
| Apr 16, 2012 |
Pulmonary Hypertension Agents-PDL |
| Apr 16, 2012 |
Pulmonary Hypertension Agents (Oral)-PDL |
| Apr 16, 2012 |
Quinolone Ophthalmic Antibiotic-PDL |
| Jul 07, 2011 |
Ranexa® |
| Jan 12, 2005 |
Raniclor™ |
| Dec 23, 2004 |
Raptiva |
| Jun 22, 2005 |
Retinoic Acid Products/Retinoid Analogues - Topical |
| Apr 10, 2012 |
Ribavirins - PDL |
| Jul 20, 2011 |
Sedative Hypnotics-PDL |
| Dec 08, 2010 |
Selective Serotonin Reuptake Inhibitor (SSRI) |
| Apr 16, 2012 |
Self Injecting Epinephrine Agents |
| Jul 07, 2011 |
Selzentry® (Maraviroc) |
| Nov 18, 2010 |
Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) |
| Sep 08, 2010 |
Skeletal Muscle |
| Feb 25, 2011 |
Smoking Cessation |
| Jun 20, 2011 |
Suboxone |
| Jul 29, 2003 |
Sucralfate (Carafate) |
| Apr 16, 2012 |
Sulfonylureas-PDL |
| Sep 16, 2010 |
Synagis (palivizumab) |
| May 12, 2006 |
Tamiflu® |
| Jul 07, 2003 |
Thalomid (thalidomide) |
| Apr 16, 2012 |
Thiazolidinediones - PDL |
| Oct 29, 2007 |
Tindamax® |
| Apr 16, 2012 |
Topical Agents for Psoriasis - PDL |
| Apr 10, 2012 |
Topical Androgenic Agents |
| Jul 20, 2011 |
Topical Benzoyl Peroxide/Clindamycin Combination |
| Apr 10, 2012 |
Topical Immunomodulators - PDL |
| Apr 16, 2012 |
Topical Retinoids - PDL |
| Apr 16, 2012 |
Tramadol Like Agents-PDL |
| Jan 16, 2004 |
Tricyclic Antidepressant Coordination of Care |
| Jul 20, 2011 |
TriGlyceride Lower Agents-PDL |
| Apr 16, 2012 |
Ulcerative Colitis Oral Agents-PDL |
| Apr 16, 2012 |
Ulcerative Colitis-Rectal-PDL |
| Jul 20, 2011 |
Urinary Tract Antispasmodics - PDL |
| Apr 15, 2009 |
Vivitrol ® |
| Mar 07, 2003 |
Voriconazole (Vfend) / Antifungal |
| Nov 13, 2003 |
Xanax XR® (Alprazolam) |
| Dec 30, 2009 |
Xolair |
| Nov 13, 2003 |
Zometa® (zoledronic acid) |
| Apr 11, 2007 |
Zostavax Injection |
| Jan 13, 2005 |
Zyprexa IM® |