Missouri Pharmacy Clinical Edits and Preferred Drug Lists

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.

Issue Date Pharmacy Clinical Edit and PDL Description
Jun 05, 2009 15 Day Limitation
Feb 07, 2013 5-HT1 Agonist (Triptan) Therapy PDL
Mar 05, 2014 ACE Inhibitors PDL
Mar 05, 2014 ACE Inhibitors/Calcium Channel Blocker Combinations PDL
Mar 05, 2014 ACE Inhibitors Diuretic Combinations
Mar 24, 2003 Actiq Lozenges
Aug 5, 2010 ADHD Therapy
Jul 07, 2003 Alinia (Nitazoxanide)/antiparasitic/antimicrobial)
Feb 07, 2013 Alpha-GlucosidaseInhibitors PDL
Feb 07, 2013 Alzheimer’s Agents (Cholinesterase Inhibitors) PDL
Feb 07, 2013 Amylin Analogs PDL
Nov 12, 2013 Amitiza®
Jul 07, 2011 Ampyra
Aug 10, 2012 Antiemetics Agents PDL
Mar 05, 2014 Angiotensin II Receptor Blocker Diuretic Combinations PDL
Mar 05, 2014 Angiotensin II Receptor Blockers PDL
Mar 05, 2014 Anticoagulants PDL
Aug 23, 2013 2nd Generation Antihistamines PDL
Aug 23, 2013 2nd Generation Antihistamines/Decongestant Combinations – PDL
Feb 07, 2013 Antihyperuricemic Agents PDL
Jul 03, 2012 Atypical Antipsychotics
Aug 22, 2013 Beta Adrenergic Agents Long Acting PDL
Aug 10, 2012 Beta Adrenergic Agents Short Acting PDL
Jan 04, 2013 Beta Adrenergic Agents/Nebulized PDL
Mar 05, 2014 Beta Adrenergic Blockers- PDL
Aug 10, 2012 BPH Agents PDL
Nov 09, 2006 BiDil® Tablets
Jan 03, 2014 Biguanides PDL
Jan 03, 2014 Bile Salts Agents PDL
Jan 03, 2014 Bone Deossification Suppression Agents PDL
Nov 12, 2013 Botulinum Toxin Type A (Botox)
Jul 05, 2011 Butorphanol
Mar 05, 2014 Calcium Channel Blockers (DHP) PDL
Mar 05, 2014 Calcium Channel Blockers (nonDHP) PDL
Mar 05, 2014 Calcium Channel Blockers/ARBS PDL
Jul 29, 2003 Cold Sore Treatment Fiscal Edit
Nov 17, 2005 Combunox® Tablets
Aug 10, 2012 COPD Agents PDL
Jul 01, 2013 Cough and Cold PDL
Feb 07, 2013 COX-2 Inhibitors PDL
Jan 03, 2014 Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL
Mar 05, 2014 Direct Renin Inhibitors PDL
Jan 03, 2014 Disease-Modifying AntiRheumatic Drug (DMARD) PDL
Nov 13, 2003 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
Jan 03, 2014 DPP-IV Inhibitors PDL
Jan 03, 2014 Electrolyte Depleters PDL
May 16, 2007 Emsam®
Jan 19, 2006 Equetro®
Feb 07, 2013 Fibromyalgia Agents
Jan 03, 2014 FluoroQuinolones-Oral PDL
Jul 28, 2003 Forteo® (teriparatide injection / Parathyroid Hormone)
Jul 07, 2003 Geodon for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible
Feb 07, 2013 GLP-1 Receptor Agonists PDL
Jan 03, 2014 Growth Hormones PDL
Jul 07, 2003 H2 Antagonists
Jan 03, 2014 Hematopoietic Agents
Jan 03, 2014 Hepatitis C Therapy PDL
Feb 07, 2013 Herpes Antivirals PDL
Mar 05, 2014 HMG Co-A reductase inhibitors (statins) PDL
Mar 05, 2014 Homozygous Familial Hypercholesterolemia
Dec 11, 2003 H-Pylori Therapy
Apr 23, 2013 Human Papillomavirus Vaccines
Aug 22, 2013 Inhaled Antibiotics PDL
Aug 22, 2013 Inhaled Corticosteroids PDL
Jan 03, 2014 Insulin Mix PDL
Jan 03, 2014 Insulin Rapid Acting PDL
Jan 03, 2014 Insulins PDL
Jan 03, 2014 Insulins Long Acting PDL
Aug 22, 2013 Intranasal Antihistamines PDL
Aug 22, 2013 Intranasal Steroids PDL
Jan 03, 2014 Intravaginal Antibiotics PDL
Nov 13, 2003 Klonopin Wafer® (clonazepam)
Nov 07, 2003 Lactulose Step Therapy Edit
Feb 07, 2013 Leukotriene PDL
Jan 03, 2014 Macrolides PDL
Jan 03, 2014 Meglintinides PDL
Aug 25, 2010 Megestrol Acetate
Nov 03, 2004 Methadone
Jan 03, 2014 Multiple Sclerosis Agents PDL
Feb 07, 2013 Narcotics, Long Acting PDL
Apr 13, 2012 Narcotics, Short Acting
Feb 09, 2012 Narcotics, Short Acting Combinations
Mar 05, 2014 Narcolepsy Inhibitors
May 29, 2013 Neuropathic Pain Agents
Mar 05, 2014 Niacin Preparations PDL
Aug 10, 2012 Non-Ergot Dopamine Receptor Agonists PDL
Jan 26, 2012 Non-Oral Contraceptives Fiscal Edit
Feb 07, 2013 Non-Sedating Antihistamines PDL
Feb 07, 2013 NSAID Agents PDL
Aug 24, 2010 NSAID Step Therapy Edit
May 03, 2007 Nubain®
May 23, 2013 Onfi (clobazam)
Feb 07, 2013 Onychomycosis Antifungal Agents PDL
Jun 20, 2007 Opana® Immediate-Release Tablets
Feb 07, 2013 Ophthalmic Antihistamines PDL
Feb 07, 2013 Ophthalmic Mast Cell Stabilizers PDL
Mar 05, 2014 Ophthalmic NSAIDs PDL
Aug 22, 2013 Ophthalmic Prostaglandin Agonists PDL
Aug 23, 2013 Ophthalmic Quinolones PDL
Feb 07, 2013 Oral AntiDiabetics: Combinations PDL
Aug 22, 2013 Otic Quinolones PDL
Jan 31, 2005 Oxandrin®
Feb 07, 2013 Pancreatic Enzyme Agents PDL
Sep 26, 2005 Prostin VR® Pediatric
Mar 05, 2014 Proton Pump Inhibitor PDL
Sep 03, 2013 Provigil (Modafanil) and Nuvigil (Armodafanil)
Nov 12, 2010 Psychotropic Medications Polypharmacy
Mar 05, 2014 Pulmonary Hypertension Agents PDL
Mar 05, 2014 Pulmonary Hypertension Agents (Oral) PDL
Feb 07, 2013 Quinolone Ophthalmic Antibiotic PDL
Jul 07, 2011 Ranexa®
Jan 12, 2005 Raniclor™
Dec 23, 2004 Raptiva
Feb 06, 2014 Relistor Injection
Jan 03, 2014 Ribavirins PDL
Aug 10, 2012 Sedative Hypnotics PDL
Dec 08, 2010 Selective Serotonin Reuptake Inhibitor (SSRI)
Feb 07, 2013 Self Injecting Epinephrine Agents
Jul 07, 2011 Selzentry® (Maraviroc)
Jul 03, 2012 Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
Aug 10, 2012 Skeletal Muscle
Feb 25, 2011 Smoking Cessation
Mar 05, 2014 Sodium-Glucose Co-Transporter 2 Inhibitors (SGT-2 Inhibitor)
Jun 20, 2011 Suboxone
Jan 03, 2014 Sulfonylureas PDL
Sep 16, 2010 Synagis (palivizumab)
Jan 03, 2014 Tetracyclines PDL
Jul 07, 2003 Thalomid (thalidomide)
Jan 03, 2014 Thiazolidinediones PDL
Oct 29, 2007 Tindamax®
Aug 22, 2013 Topical Agents for Psoriasis PDL
Aug 22, 2013 Topical Androgenic Agents
Aug 29, 2013 Topical Antiparasitics Agents
Aug 22, 2013 Topical Benzoyl Peroxide/Clindamycin Combination
Feb 07, 2013 Topical Immunomodulators PDL
Aug 22, 2013 Topical Retinoids PDL
Aug 22, 2013 Topical Steroids PDL
Feb 07, 2013 Tramadol Like Agents PDL
Jan 16, 2004 Tricyclic Antidepressant Coordination of Care
Mar 05, 2014 TriGlyceride Lower Agents PDL
Aug 22, 2013 Ulcerative Colitis Oral Agents PDL
Aug 22, 2013 Ulcerative Colitis-Rectal PDL
Jan 03, 2014 Urinary Tract Antispasmodics PDL
Jul 03, 2012 Vivitrol ®
Mar 07, 2003 Voriconazole (Vfend) / Antifungal
Nov 13, 2003 Xanax XR® (Alprazolam)
Dec 30, 2009 Xolair
Nov 13, 2003 Zometa® (zoledronic acid)
Jul 03, 2012 Zostavax Injection
Jan 13, 2005 Zyprexa IM®