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
06/05/2009 15 Day Limitation
02/07/2013 5-HT1 Agonist (Triptan) Therapy PDL
03/05/2014 ACE Inhibitors PDL
03/05/2014 ACE Inhibitors/Calcium Channel Blocker Combinations PDL
03/05/2014 ACE Inhibitors Diuretic Combinations
03/23/2003 Actiq Lozenges
08/05/2010 ADHD Therapy
07/07/2003 Alinia (Nitazoxanide)/antiparasitic/antimicrobial)
02/07/2013 Alzheimer’s Agents (Cholinesterase Inhibitors) PDL
11/12/2013 Amitiza®
07/07/2011 Ampyra
08/10/2012 Antiemetics Agents PDL
03/05/2014 Angiotensin II Receptor Blocker Diuretic Combinations PDL
03/05/2014 Angiotensin II Receptor Blockers PDL
03/05/2014 Anticoagulants PDL
10/28/2014 2nd Generation Antihistamines PDL
08/23/2013 2nd Generation Antihistamines/Decongestant Combinations – PDL
12/04/2014 Antihyperuricemic Agents PDL
Jul 03, 2012 Atypical Antipsychotics
10/28/2014 Beta Adrenergic Agents Long Acting PDL
10/28/2014 Beta Adrenergic Agents Short Acting PDL
10/28/2014 Beta Adrenergic Agents/Nebulized PDL
03/05/2014 Beta Adrenergic Blockers- PDL
12/04/2014 Biologics Disease Modifying AntiRheumatic Drugs DMARDS Immunomodulators
12/04/2014 BPH Agents (formerly Androgen Hormone Inhibitors)
11/09/2006 BiDil® Tablets
12/04/2014 Bile Salts Agents PDL
01/03/2014 Bone Deossification Suppression Agents PDL
11/12/2013 Botulinum Toxin Type A (Botox)
07/05/2011 Butorphanol
03/05/2014 Calcium Channel Blockers (DHP) PDL
03/05/2014 Calcium Channel Blockers (nonDHP) PDL
03/05/2014 Calcium Channel Blockers/ARBS PDL
07/29/2003 Cold Sore Treatment Fiscal Edit
11/17/2005 Combunox® Tablets
10/28/2014 COPD Agents PDL
07/01/2013 Cough and Cold PDL
02/07/2013 COX-2 Inhibitors PDL
01/03/2014 Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL
03/05/2014 Direct Renin Inhibitors PDL
11/13/2003 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
12/04/2014 DPP-IV Inhibitors PDL
12/04/2014 Electrolyte Depleters PDL
05/16/2007 Emsam®
01/19/2006 Equetro®
02/07/2013 Fibromyalgia Agents
12/04/2014 FluoroQuinolones-Oral PDL
07/28/2003 Forteo® (teriparatide injection / Parathyroid Hormone)
07/07/2003 Geodon for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible
12/04/2014 GLP-1 Receptor Agonists PDL
12/04/2014 Growth Hormones PDL
07/07/2003 H2 Antagonists
12/04/2014 Hematopoietic Agents
12/04/2014 Hepatitis C Therapy PDL
10/28/2014 Herpes Antivirals PDL
03/05/2014 HMG Co-A reductase inhibitors (statins) PDL
03/05/2014 Homozygous Familial Hypercholesterolemia
12/11/2003 H-Pylori Therapy
04/23/2013 Human Papillomavirus Vaccines
10/28/2014 Inhaled Antibiotics PDL
10/28/2014 Inhaled Corticosteroids PDL
12/04/2014 Insulins Long Acting PDL
12/04/2014 Insulins Mix PDL
12/04/2014 Insulins PDL
12/04/2014 Insulins Rapid Acting PDL
10/28/2014 Intranasal Antihistamines PDL
10/28/2014 Intranasal Steroids PDL
12/04/2014 Intravaginal Antibiotics PDL
11/13/2003 Klonopin Wafer® (clonazepam)
11/07/2003 Lactulose Step Therapy Edit
10/28/2014 Leukotriene PDL
12/04/2014 Macrolides -Adult
12/04/2014 Macrolides -Pediatric
08/25/2010 Megestrol Acetate
11/03/2004 Methadone
12/04/2014 Multiple Sclerosis Agents PDL
02/07/2013 Narcotics, Long Acting PDL
04/13/2012 Narcotics, Short Acting
02/09/2012 Narcotics, Short Acting Combinations
03/05/2014 Narcolepsy Inhibitors
05/29/2013 Neuropathic Pain Agents
03/05/2014 Niacin Preparations PDL
08/10/2012 Non-Ergot Dopamine Receptor Agonists PDL
01/26/2012 Non-Oral Contraceptives Fiscal Edit
02/07/2013 Non-Sedating Antihistamines PDL
02/07/2013 NSAID Agents PDL
08/24/2010 NSAID Step Therapy Edit
05/03/2007 Nubain®
05/23/2013 Onfi (clobazam)
10/28/2014 Onychomycosis Antifungal Agents PDL
06/20/2007 Opana® Immediate-Release Tablets
10/28/2014 Ophthalmic Antihistamines PDL
10/28/2014 Ophthalmic Mast Cell Stabilizers PDL
10/28/2014 Ophthalmic NSAIDs PDL
10/28/2014 Ophthalmic Prostaglandin Agonists PDL
10/28/2014 Ophthalmic Quinolones PDL
12/04/2014 Oral AntiDiabetic: Amylin Analogs PDL
12/04/2014 Oral AntiDiabetic: Alpha-GlucosidaseInhibitors PDL
12/04/2014 Oral AntiDiabetic: Biguanides PDL
12/04/2014 Oral AntiDiabetic: Combinations PDL
12/04/2014 Oral AntiDiabetic: Meglintinides PDL
12/04/2014 Oral AntiDiabetic: Sulfonylureas 2nd Generation
12/04/2014 Oral AntiDiabetic: Thiazolidinediones PDL
10/28/2014 Otic Quinolones PDL
01/31/2005 Oxandrin®
10/28/2014 Pancreatic Enzyme Agents PDL
09/26/2005 Prostin VR® Pediatric
03/05/2014 Proton Pump Inhibitor PDL
09/03/2013 Provigil (Modafanil) and Nuvigil (Armodafanil)
11/12/2010 Psychotropic Medications Polypharmacy
03/05/2014 Pulmonary Hypertension Agents PDL
03/05/2014 Pulmonary Hypertension Agents (Oral) PDL
02/07/2013 Quinolone Ophthalmic Antibiotic PDL
07/07/2011 Ranexa®
01/12/2005 Raniclor™
12/23/2004 Raptiva
02/06/2014 Relistor Injection
12/04/2014 Ribavirins PDL
08/10/2012 Sedative Hypnotics PDL
12/08/2010 Selective Serotonin Reuptake Inhibitor (SSRI)
10/28/2014 Self Injecting Epinephrine Agents
07/07/2011 Selzentry® (Maraviroc)
07/03/2012 Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
08/10/2012 Skeletal Muscle
02/25/2011 Smoking Cessation
12/04/2014 Sodium-Glucose Co-Transporter 2 Inhibitors (SGT-2 Inhibitor)
06/20/2011 Suboxone
09/16/2010 Synagis (palivizumab)
12/04/2014 Tetracyclines PDL
07/07/2003 Thalomid (thalidomide)
10/29/2007 Tindamax®
10/28/2014 Topical Agents for Psoriasis PDL
10/28/2014 Topical Androgenic Agents
12/02/2014 Topical Antifungal Agents
10/28/2014 Topical Antiparasitics Agents
10/28/2014 Topical Antiviral Agents
10/28/2014 Topical Benzoyl Peroxide/Clindamycin Combination
10/28/2014 Topical Immunomodulators PDL
10/28/2014 Topical Retinoids PDL
10/28/2014 Topical Steroids PDL
02/07/2013 Tramadol Like Agents PDL
01/16/2004 Tricyclic Antidepressant Coordination of Care
03/05/2014 TriGlyceride Lower Agents PDL
10/28/2014 Ulcerative Colitis Oral Agents PDL
10/28/2014 Ulcerative Colitis-Rectal PDL
12/04/2014 Urinary Tract Antispasmodics PDL
07/03/2012 Vivitrol ®
03/07/2003 Voriconazole (Vfend) / Antifungal
11/13/2003 Xanax XR® (Alprazolam)
12/30/2009 Xolair
11/13/2003 Zometa® (zoledronic acid)
07/03/2012 Zostavax Injection
01/13/2005 Zyprexa IM®