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
06/05/09 15 Day Limitation
05/22/15 5-HT1 Agonist (Triptan) Therapy PDL
02/02/15 ACE Inhibitors PDL
02/02/15 ACE Inhibitors/Calcium Channel Blocker Combinations PDL
02/02/15 ACE Inhibitors Diuretic Combinations
03/23/03 Actiq Lozenges
02/19/15 ADHD Therapy
07/07/03 Alinia (Nitazoxanide)/antiparasitic/antimicrobial)
05/22/15 Alzheimer’s Agents (Cholinesterase Inhibitors) PDL
11/12/13 Amitiza®
07/07/11 Ampyra
05/22/15 Antiemetics Agents PDL
02/02/15 Angiotensin Receptor Blocker Diuretic Combinations PDL
02/02/15 Angiotensin Receptor Blockers PDL
02/02/15 Anticoagulants PDL
10/28/14 2nd Generation Antihistamines PDL
08/23/13 2nd Generation Antihistamines/Decongestant Combinations – PDL
02/23/15 Antihyperuricemic Agents PDL
Jul 03, 2012 Atypical Antipsychotics
10/28/14 Beta Adrenergic Agents Long Acting PDL
10/28/14 Beta Adrenergic Agents Short Acting PDL
10/28/14 Beta Adrenergic Agents/Nebulized PDL
02/02/15 Beta Adrenergic Blockers- PDL
12/04/14 Biologics Disease Modifying AntiRheumatic Drugs DMARDS Immunomodulators
12/04/14 BPH Agents (formerly Androgen Hormone Inhibitors)
11/09/06 BiDil® Tablets
12/04/14 Bile Salts Agents PDL
01/03/14 Bone Deossification Suppression Agents PDL
11/12/13 Botulinum Toxin Type A (Botox)
07/05/11 Butorphanol
02/02/15 Calcium Channel Blockers (DHP) PDL
02/02/15 Calcium Channel Blockers (nonDHP) PDL
02/02/15 Calcium Channel Blockers/ARBS PDL
07/29/03 Cold Sore Treatment Fiscal Edit
11/17/05 Combunox® Tablets
10/28/14 COPD Agents PDL
07/01/13 Cough and Cold PDL
05/22/15 COX-2 Inhibitors PDL
01/03/14 Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL
02/02/15 Direct Renin Inhibitors PDL
11/13/03 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
12/04/14 DPP-IV Inhibitors PDL
12/04/14 Electrolyte Depleters PDL
05/16/07 Emsam®
01/19/06 Equetro®
05/22/15 Fibromyalgia Agents
12/04/14 FluoroQuinolones-Oral PDL
07/28/03 Forteo® (teriparatide injection / Parathyroid Hormone)
07/07/03 Geodon for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible
12/04/14 GLP-1 Receptor Agonists PDL
12/04/14 Growth Hormones PDL
07/07/03 H2 Antagonists
12/04/14 Hematopoietic Agents
12/04/14 Hepatitis C Therapy PDL
10/28/14 Herpes Antivirals PDL
03/05/15 HMG Co-A reductase inhibitors (statins) PDL
02/02/15 Homozygous Familial Hypercholesterolemia
12/11/03 H-Pylori Therapy
04/23/13 Human Papillomavirus Vaccines
10/28/14 Inhaled Antibiotics PDL
10/28/14 Inhaled Corticosteroids PDL
12/04/14 Insulins Long Acting PDL
12/04/14 Insulins Mix PDL
12/04/14 Insulins PDL
12/04/14 Insulins Rapid Acting PDL
10/28/14 Intranasal Antihistamines PDL
10/28/14 Intranasal Steroids PDL
12/04/14 Intravaginal Antibiotics PDL
11/13/03 Klonopin Wafer® (clonazepam)
11/07/03 Lactulose Step Therapy Edit
10/28/14 Leukotriene PDL
12/04/14 Macrolides -Adult
12/04/14 Macrolides -Pediatric
08/25/10 Megestrol Acetate
11/03/04 Methadone
12/04/14 Multiple Sclerosis Agents PDL
05/22/15 Narcotics, Long Acting PDL
04/13/12 Narcotics, Short Acting
02/09/12 Narcotics, Short Acting Combinations
03/05/14 Narcolepsy Inhibitors
05/22/15 Neuropathic Pain Agents
02/02/15 Niacin Preparations PDL
05/22/15 Non-Ergot Dopamine Receptor Agonists PDL
01/26/12 Non-Oral Contraceptives Fiscal Edit
02/07/13 Non-Sedating Antihistamines PDL
05/22/15 NSAID Agents PDL
08/24/10 NSAID Step Therapy Edit
05/03/07 Nubain®
05/23/13 Onfi (clobazam)
10/28/14 Onychomycosis Antifungal Agents PDL
06/20/07 Opana® Immediate-Release Tablets
10/28/14 Ophthalmic Antihistamines PDL
10/28/14 Ophthalmic Mast Cell Stabilizers PDL
10/28/14 Ophthalmic NSAIDs PDL
10/28/14 Ophthalmic Prostaglandin Agonists PDL
10/28/14 Ophthalmic Quinolones PDL
12/04/14 Oral AntiDiabetic: Amylin Analogs PDL
12/04/14 Oral AntiDiabetic: Alpha-GlucosidaseInhibitors PDL
12/04/14 Oral AntiDiabetic: Biguanides PDL
12/04/14 Oral AntiDiabetic: Combinations PDL
12/04/14 Oral AntiDiabetic: Meglintinides PDL
12/04/14 Oral AntiDiabetic: Sulfonylureas 2nd Generation
12/04/14 Oral AntiDiabetic: Thiazolidinediones PDL
10/28/14 Otic Quinolones PDL
01/31/05 Oxandrin®
10/28/14 Pancreatic Enzyme Agents PDL
09/26/05 Prostin VR® Pediatric
02/02/15 Proton Pump Inhibitor PDL
09/03/13 Provigil (Modafanil) and Nuvigil (Armodafanil)
11/12/10 Psychotropic Medications Polypharmacy
02/02/15 Pulmonary Hypertension Agents PDL
02/02/15 Pulmonary Hypertension Agents (Oral) PDL
02/07/13 Quinolone Ophthalmic Antibiotic PDL
07/07/11 Ranexa®
01/12/05 Raniclor™
12/23/04 Raptiva
02/06/14 Relistor Injection
12/04/14 Ribavirins PDL
05/22/15 Sedative Hypnotics PDL
12/08/10 Selective Serotonin Reuptake Inhibitor (SSRI)
10/28/14 Self Injecting Epinephrine Agents
07/07/11 Selzentry® (Maraviroc)
07/03/12 Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
05/22/15 Skeletal Muscle Relaxants
12/04/14 Sodium-Glucose Co-Transporter 2 Inhibitors (SGT-2 Inhibitor)
06/20/11 Suboxone
09/16/10 Synagis (palivizumab)
12/04/14 Tetracyclines PDL
07/07/03 Thalomid (thalidomide)
10/29/07 Tindamax®
10/28/14 Topical Agents for Psoriasis PDL
10/28/14 Topical Androgenic Agents
12/02/14 Topical Antifungal Agents
10/28/14 Topical Antiparasitics Agents
10/28/14 Topical Antiviral Agents
10/28/14 Topical Benzoyl Peroxide/Clindamycin Combination
10/28/14 Topical Immunomodulators PDL
10/28/14 Topical Retinoids PDL
10/28/14 Topical Steroids PDL
05/22/15 Tramadol-like Agents PDL
01/16/04 Tricyclic Antidepressant Coordination of Care
02/02/15 TriGlyceride Lower Agents PDL
10/28/14 Ulcerative Colitis Oral Agents PDL
10/28/14 Ulcerative Colitis-Rectal PDL
12/04/14 Urinary Tract Antispasmodics PDL
07/03/12 Vivitrol ®
03/07/03 Voriconazole (Vfend) / Antifungal
11/13/03 Xanax XR® (Alprazolam)
12/30/09 Xolair
11/13/03 Zometa® (zoledronic acid)
07/03/12 Zostavax Injection
01/13/05 Zyprexa IM®