2023

Draft October Minutes
Agenda
Edit Implementation Schedule
PDL Announcements
PDL Recommendations
New Drugs & Edits with No Changes
Drug Prior Authorization Process
December 2022 DUR Reports

Clinical Edit Proposals - No New Criteria

Aduhelm Clinical Edit
Antipsychotics - 1st Generation (Typical) Clinical Edit
Benzodiazepines (Select Oral) Clinical Edit
Butalbital Combinations without Codeine Clinical Edit
Corlanor Clinical Edit
Empaveli Clinical Edit
HBV Nucleotide Analog Reverse Transcriptase Inhibitors Fiscal Edit
High Risk Therapies Clinical Edit
Kerendia Clinical Edit
Morphine Milligram Equivalent Accumulation Clinical Edit
Non-Oral Contraceptives Fiscal Edit
Oxazolidinone Fiscal Edit
Pompe Disease Clinical Edit
Selzentry Clinical Edit
Transmucosal Immediate Release Fentanyl (TIRF) Clinical Edit
Verquvo Clinical Edit

Clinical Edit Proposals – New Criteria or Revision of Existing Criteria

Camzyos™ Clinical Edit
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators Clinical Edit
Opioids – Short-Acting Clinical Edit
Skysona Clinical Edit
Xenpozyme Clinical Edit
Ztalmy Clinical Edit
Zynteglo Clinical Edit

Resource List Edit Review

New Criteria or Revision of Existing Criteria

Antipsychotics - 2nd Generation (Atypical) Depot Agents Resource List
Antipsychotics - 2nd Generation (Atypical) Oral & Transdermal Agents Resource List

Preferred Drug List Edit Review

Existing Criteria

Alzheimer’s Agents, Acetylcholinesterase Inhibitors, N-Methyl-D-Aspartate Receptor Antagonists & Combinations PDL Edit
Antiemetics, 5-HT3 and NK1 Injectables PDL Edit
Antiemetics, 5-HT3, NK1 and Other Select Non-Injectables PDL Edit
Antiplatelet Agents PDL Edit
Anti-Migraine, Serotonin (5-HT1) Receptor Agonists PDL Edit
Anti-Parkinsonism, MAO-B Inhibitors PDL Edit
Anti-Parkinsonism Non-Ergot Dopamine Agonists PDL Edit
Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors PDL Edit
Glucagon Agents PDL Edit
Hereditary Angioedema Agents PDL Edit
NSAIDs PDL Edit
Opioid Emergency Reversal Agents PDL Edit
Opioids, Long Acting PDL Edit
Somatostatin Analogs PDL Edit
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors PDL Edit

Preferred Drug List Edit Review New Criteria or Revision of Existing Criteria

Anticonvulsants, Dravet Syndrome PDL Edit
Anti-Migraine, Alternative Oral Agents PDL Edit
Antiandrogenic Agents PDL Edit
Antiretroviral Therapy (ART) PDL Edit
Calcitonin Gene-Related Peptide (CGRP) Inhibitors PDL Edit
Fibromyalgia Agents PDL Edit
GI Motility Agents, Chronic PDL Edit
Mitogen-activated Extracellular Kinase Inhibitors (MEKi) & B-raf Kinase Inhibitors (BRAFi) PDL Edit
Neuropathic Pain Agents PDL Edit
Opioid and Select Alcohol Dependence Agents PDL Edit
Sedative Hypnotics PDL Edit
Skeletal Muscle Relaxants PDL Edit
Tramadol-Like Agents PDL Edit

2022

Draft October Meeting Minutes
Agenda
Edit Implementation Schedule
New Drugs and Edits with No Annual Changes
PDL Announcements
PDL Recommendations
Missouri DUR Board Retrospective - DUR Interventions
MO Healthnet Pharmacy Program and Budget Update
Preventing Overdose in Patients Using Medication-Assisted Treatment

Conduent Reports

Conduent Reports

Clincial Edit Proposals – No New Criteria

Entresto
SMA

Clincial Edit Proposals – New Revised Criteria

Alpelisib
ATTR

PDL Proposals – No New Criteria

ACEI_ACEI-Diuretic Combinations
ACEI_CCB Combinations
ADHD, Methylphenidate SA
ADHD, Non-Stimulants
Alpha Glucosidase Inhibitors
Amylin Analogs
Antibiotics, Mupirocin Topical
Antihyperuricemic Agents
ARB_ARB-Diuretic Combos
ARB-CCB Combos
BB_BB-Diuretic Combos
Benign Prostatic Hyperplasia (BPH) Agents
Biguanides and Combination Agents
Bone Ossification Agents
CCB, Non-DHP
Cephalosporins
Direct Renin Inhibitors and Combos
DPPIV Inhibitors
Electrolyte Depleting Agents, Phosphate Lowering
Fluoroquinolones, Oral
Homozygous Familial Hypercholesterolemia (HoFH)
Insulin, Mixed
Insulin, Non-Analogs
Insulin, Rapid Acting
Macrolides
Meglitinides
Methotrexate Agents
Niacin Derivatives
PAH, ETRAs
PAH, PDE5-SGC
PAH, Prostacyclins Oral
Penicillins
SGLT2 Inhibitors
Statins and Combos
Sulfonylurea Agents, Second Generation
Tetracyclines
Thiazolidinediones and Combinations
Thrombocytopenia Agents
Triglyceride Lowering Agents

PDL Proposals – New Revised Criteria

ADHD, Amphetamines Long Acting
ADHD, Amphetamines Short Acting
ADHD, Methylphenidate Long Acting
Antibiotics, GI Oral
Antibiotics, Vaginal
Anticoagulants, Oral and Subcutaneous
Anticonvulsants, Rescue Agents
Bile Salt Agents
CCB, DHP
Colony Stimulating Factors
Cryopyrin-Associated Periodic Syndrome (CAPS)
Dry Eye Disease Agents
Electrolyte Depleting Agents, Potassium Lowering
Erythropoiesis Stimulating Agents
GLP-1 Receptor Agonists and Combination Agents
Growth Hormone Agents, Somatropin
Growth Hormone and Growth Hormone Releasing Factors, Select Agents
Insulin, Long Acting
LHRH, GnRH Agents, Non-Oral
LHRH, GnRH Agents, Oral
Multiple Sclerosis Agents, Injectable
Multiple Sclerosis Agents, Oral
PAH, Prostacyclins Inhaled
PAH, Prostacyclins Injectable
PCSK9 Inhibitor
Proton Pump Inhibitors (PPIs)
Sympatholytics
Targeted Immune Modulators JAK Inhibitors
Targeted Immune Modulators, IL6 Receptor Inhibitors
Targeted Immune Modulators, IL17 Receptor Antagonists
Targeted Immune Modulators, IL23-12 Inhibitors
Targeted Immune Modulators, Misc Allergy and Asthma Related Monoclonal Antibodies
Targeted Immune Modulators, Select Agents
Targeted Immune Modulators, TNF Inhibitors
Urinary Tract Antispasmodics

Minutes
Agenda
MHD Rescue Inhaler Policy
Edit Implementation Schedule
PDL Announcements
PDL Recommendations
New Drugs & Edits with No Annual Changes Presentation
March DPAC Reports

Clinical Edit Proposals – No New Criteria:
Imcivree
Megestrol Acetate
Nulibry
Oxervate
Oxlumo
Spravato
Zokinvy
Zulresso

Clinical Edit Proposals – New Revised Criteria:
Acne or Rosacea - Select Topical Agents
C5 Complement Inhibitors
CFTR Modulators
Fabry Disease
Givlaari
Isturisa
Scenesse
Sickle Cell Disease
Systemic Antifungals
Tavneos
Voxzogo

PDL Proposals – No New Criteria:
Actinic Keratosis Agents, Topical
Androgenic Agents
Antibiotics, Inhaled
Antifungals, Topical
Antihistamines and Antihistamine-Decongestant Combinations, Second Generation
Antihistamines, Intranasal
Antivirals, Herpes Oral
Antivirals, Topical
Benzoyl Peroxide-Antibiotic Combinations
Corticosteriods, Oral Inhaled
Corticosteroids and Rhinitis Agents, Intranasal
Corticosteroids, Topical
Cough-Cold Preparation
Epinephrine Agents, Self-Injectable
Fluoroquinolones, Ophthalmic
Fluoroquinolones, Otic
Glaucoma Agents
Mast Cell Stabilizers, Ophthalmic
NSAIDS, Ophthalmic
Psoriasis Agents, Oral
Psoriasis Agents, Topical
Retinoids, Topical
Ulcerative Colitis Agents, Oral
Ulcerative Colitis Agents, Rectal

PDL Proposals – New Revised Criteria:
Anticholinergics LABAs-ICS Combinations and PDE4 Inhibitors
Anticholinergics, Long Acting Beta Adrenergics Combinations
Anticholinergics, Long Acting Inhaled
Anticholinergics, Short Acting and Combinations Inhaled
Antifungals, Oral
Antihistamines, Ophthalmic
Antiparasitics, Topical
Atopic Dermatitis Agents, Immunomodulators
Beta Adrenergic Agents, Short Acting
Beta Adrenergic Agents, Long Acting
Beta Adrenergic Agents, Nebulized
Corticosteroids, Ophthalmic Soft
Hepatitis C Agents
Leukotriene Receptor Modifiers
Pancreatic Enzymes
Respiratory Monoclonal Antibodies

Minutes
Agenda
Edit Implementation Schedule
PDL Announcements
PDL Recommendations
New Drugs & Edits with No Changes

Pharmacy Program & Budget Update Presentation

Conduent Reports

January 2022 DUR Reports

Opioid Policy Review Edits/Proposals

High Risk Therapies
MHD Opioid Policy Update
MME
Opioid Dependence Agents
Opioid Emergency Reversal Agents
Opioids, Long Acting
Opioids, Short Acting
TIRF
Tramadol-Like Agents

PDL Proposals - No New Criteria

Alzheimer's Agents
Anticonvulsants, Dravet Syndrome
Antiemetics, THC Derivativ1
Anti-Parkinsonism, MAO-B Inhibitors
Anti-Parkinsonism, Non-Ergot Dopamine Agonists
GI Motility Agents, Chronic
Somatostatin Analogs

PDL Proposals – New Revised Criteria

Antiandrogenic Agents
Antiemetics, 5-HT3 and NK1 Injectables
Antiemetics, 5-HT3, NK1 and Other Select Non-Injectables
Anti-Migraine, Alternative Oral Agents
Anti-Migraine, Serotonin (5-HT1) Receptor Agonists
Antiretroviral Therapy (ART)
Bile Salt Agents
Calcitonin Gene-Related Peptide (CGRP) Inhibitor
CDK4-6 Inhibitors
Fibromyalgia Agents
Glucagon Agents
Hereditary Angioedema Agents
Homozygous Familial Hypercholesterolemia (HoFH)
Neuropathic Pain Agents
NSAIDs
Sedative Hypnotics
Skeletal Muscle Relaxants
VMAT2 Inhibitors

Clinical Edits – No New Criteria

15 Day Supply Oral Oncology
Butalbital Combo Without Codeine
Butalbital Combo Excessive Therapy
Diabetic Supply Quantity
Out of State Pharmacies
Selzentry

Clinical Edits – New Revised Criteria

15 Day Supply
Antipsychotics, 1st Gen (Typical)
Antipsychotics, 2nd Gen (Atypical)
APAP Accumulation
Benzodiazepines Select Oral
BiDil
Biosimilar vs Reference Products
Corlanor
Empaveli
Extended Supply
High Cost Medications
Kerendia
Non-Oral Contraceptives
Pompe Disease
SMA

2021

DUR Minutes 1-20-21 Approved
Agenda
January 2021 Draft Meeting Minutes
Edit Implementation Schedule
PDL Announcements
PDL Recommendations
New Drugs & Edits with No Annual Changes

Conduent Reports

Helpdesk Status Report
Logging Table
MO User Stats
New Drug Summary
Top 25 Drugs Quarterly Report

Clinical Edit Proposals

15 Day Supply
15 Day Supply Oral Oncology
Antipsychotics, 1st Generation (Typical)
Antipsychotics, 2nd Generation (Atypical)
APAP Accumulation
Benzodiazepines Select Oral
BiDil
Biosimilar vs Reference
Butalbital Combo without Codeine
Butabital Combo Excessive Therapy
Car T Cell
Corlanor
Diabetic Supply Quantity
DMD
Entresto
High Cost Medication Kits
High Risk Therapies
Isturisa
MME
NMOSD
Non-Oral Contraceptive
Opioids Single Agent – Short Acting
Out of State Pharmacies
PolyPharm
PrEP
Selzentry
SMA
TIRF

Preferred Drug List Proposals

Alzheimer’s Agents
Antiandrongenic Agents
Anticonvulsants, Dravet Syndrome
Antiemetic 5HT3, NK1, Other Non-Injectable Agents
Antiemetic 5HT3_NK1 Agents, Injectable
Antiemetic THC Derivative Agents
Anti-Migraine Alternative Oral Agents
Anti-Migraine, 5-HT1 Agents
Anti-Parkinsonism, MAO-B Inhibitor Agents
Anti-Parkinsonism, Non-Ergot Dopamine Agonists
Antiretroviral Reference Products
Calcitonin Gene-Related Peptide (CGRP) Inhibitors
CDK4-6 Inhibitors
Fibromyalgia Agents
GI Motility Agents
Glucagon Agents
Hereditary Angioedema
Neuropathic Pain
NSAID Agents
Opioid Dependence Agents
Opioids, Long Acting
Opioids Combos Short-Acting
Sedative Hypnotics
Skeletal Muscle Relaxants
Somatostatic Analogs
Tramadol-Like Agents
VMAT2 Inhibitors

DUR Minutes 4-21-21 Approved
Agenda
Edit Implementation Schedule
PDL Announcement
PDL Recommendations

CONDUENT REPORTS:

MO User Statistic

Clinical Edit Proposals-No New Criteria:

Acne or Rosacea – Select Topical Agents
Givlaari
Megestrol
Sickle Cell Disease
Systemic Antifungals
Zulresso

Clinical Edit Proposals-New Revised Criteria:

CFTR
Clobazam Agents
Fabry Disease
Nocturnal Polyuria
Opioids – Single Agent Short Acting Oxlumo
Spravato

PDL Proposals-No New Criteria:

Actinic Keratosis Agents, Topical
Antifungals, Oral
Antihistamines, Intranasal
Antihistamines-Decongestant Combinations, Second Generation
Antivirals, Oral
Antivirals, Topical
Benzoyl Peroxide-Antibiotic Combinations
Beta Adrenergic Agents, Long Acting
Beta Adrenergic Agents, Nebulized
Cough-Cold Preparations
Fluoroquinolones, Ophthalmic
Mast Cell Stabilizers, Ophthalmic
NSAIDS, Ophthalmic
Pancreatic Enzymes
Psoriasis Agents, Oral
Psoriasis Agents, Topical
Retinoids, Topical
Ulcerative Colitis Agents, Rectal

PDL Proposals-New Revised Criteria:

Androgenic Agents
Antibiotics, Inhaled
Antifungals, Topical
Antihistamines, Ophthalmic
Antiparasitics, Topical
Atopic Dermatitis Agents, Immunomodulators
Beta Adrenergic Agents, Short Acting
COPD Agents
Corticosteroids, Inhaled
Corticosteroids, Intranasal
Corticosteroids, Ophthalmic Soft
Corticosteroids, Topical
Epinephrine Agents, Self-Injectable
Fluoroquinolones, Otic
Glaucoma Agents
Hepatitis C Agents
Hereditary Angioedema (HAE)
Leukotriene Receptor Modifiers
Respiratory Monoclonal Antibodies
Ulcerative Colitis Agents, Oral

DUR Minutes 7-21-21
Agenda
PDL Recommendations
New Drugs
Edit Implementation Schedule
PDL Announcements

Conduent Reports:

CyberAccess User Statistics
June 2021 DPAC Reports

PDL Proposals – No New Criteria

Amylin Analogs
Antibiotic, Vaginal
Bile Sale Agents
Cephalosporin Agents
Electrolyte Depleting Agents, Phosphate Lowering
Electrolyte Depleting Agents, Potassium Lowering
Fluoroquinolone Agents, Oral
Insulin, Mixed
Insulin, Non-Analogs
Penicillin Agents
Sulfonylurea Agents, Second Generation
Targeted Immune Modulators, IL6 Receptor Inhibitors
Thrombocytopenia Agents

PDL Proposals – New Revised Criteria

Alpha Glucosidase Inhibitors
Antibiotics, GI Oral
Antibiotics, Mupirocin Topical
Antihyperuricemic Agents
Benign Prostatic Hyperplasia Agents
Biguanides
Bone Ossification Agents
Colony Stimulating Factors
Cryopyrin-Associated Periodic Syndrome (CAPS)
DPPIV Inhibitor
Erythropoiesis Stimulating Agents
GLP-1 Agonists
Growth Hormone Agents, Somatropin
Growth Hormone, Growth Hormone Releasing Factors, Select Agents
Insulin, Long Acting
Insulin, Rapid Acting
LHRH_GnRH Agents, Non-Oral
Macrolide Agents
Meglitinide Agents
Methotrexate Agents
Multiple Sclerosis Agents, Injectable
Multiple Sclerosis Agents, Oral
SGLT2 Inhibitors
Targeted Immune Modulators, IL17
Targeted Immune Modulators, IL23 IL12 inhibitors
Targeted Immune Modulators, JAK Inhibitors
Targeted Immune Modulators, Select Agents
Targeted Immune Modulators, TNF Inhibitors
Tetracycline Agents
Thiazolidinediones
Urinary Tract Antispasmodics

Clinical Edits – No New Criteria

Ampyra
Elagolix
Gamifant
Koselugo
Luxturna
Oxervate
Reblozyl
Synagis
Tepezza
Tolvaptan
Zometa

Clinical Edits – New Revised Criteria

CAR-T Cell
Crysvita
DMD
Entresto
Extended Supply
HBV Nucleotide Analog
Imcivree
Iron – Injectable
Nulibry
Oxazolidinone
Palynziq
PTH and Other Agents
Verquvo
Zokinvy

Agenda
October 20, 2021 Meeting Minutes - Draft
Edit Implementation Schedule
PDL Announcements
PDL Recommendations
New Drugs & Edits With No Annual Changes Presentation
DUR Board Meeting Proposed Retrospective DUR Presentation

Conduent Reports:

September 2021 DPAC Reports

PDL Proposals – No New Criteria:

Angiotensin Receptor Blocker/Angiotensin Receptor Blocker Combo
Angiotensin Receptor Blocker/Calcium Channel Blocker Combo
Calcium Channel Blockers, Dihydropyridines
Calcium Channel Blockers, Non-Dihydropyridines
Direct Renin Inhibitors & Combos
Dry Eye Disease Agents
Niacin Derivatives
PAH Agents, ETRAs
PAH Agents, Prostacylin Pathway Agonists, Inhaled
PAH Agents, Prostacyclin Pathway Agonists, Oral
Sympatholytic Agents

PDL Proposals – New Revised Criteria:

ACE Inhibitors and ACE Inhibitors/Diuretic Combo
ACE Inhibitor/Calcium Channel Blocker Combinations
ADHD, Amphetamines Long Acting
ADHD, Amphetamines Short Acting
ADHD, Methylphenidate Long Acting
ADHD, Methylphenidate Short Acting
ADHD, Non-Stimulant Agents
Anticoagulant Agents, Oral and Subcutaneous
Anticonvulsants, Rescue Agents
Antiplatelet Agents
Beta Adrenergic Blockers and Beta Adrenergic Blockers/Diuretic Combo
PAH Agents, PDE5 and SGC Stimulators
PAH Agents, Prostacyclin Pathway Agonists, Injectable
PCSK9 Inhibitors
Proton Pump Inhibitors
Statins and Combinations
Triglyceride Lowering Agents

Clinical Edits – No New Criteria:

Emsam
Immunoglobulins
Lambert-Eaton Myasthenic Syndrome
Neuromyelitis Optica Spectrum Disorder
Nuedexta
Oxandrin
Palforzia
Ranexa
Xcopri

Clinical Edits – New Revised Criteria:

Aduhelm
Botulinum Toxin
Equetro
Narcolepsy Inhibitors
Psychotropic Medications Polypharmacy
Serotonin and Norepinephrine Reuptake Inhibitors
Selective Serotonin Reuptake Inhibitor
Transthyretin-Mediated Amyloidosis

2020

Agenda
Minutes
Edit Implementation Schedule
New Drugs
PDL Announcement
PDL Recommendations

Clinical Edits

Acne or Rosacea – Select Topical Agents
Clobazam Agents
DMD
Epidiolex
Galafold
Givlaari
Megestrol Acetate
Nocturnal Polyuria
Reblozyl
Sickle Cell Disease
Spravato
Systemic Antifungals

Preferred Drug List (PDL)

Actinic Keratosis Agents - Topical
Androgenic Agents
Antibiotics – Inhaled Agents
Antifungal Agents – Oral
Antifungal Agents – Topical
Antihistamines – Intranasal
Antihistamines – Ophthalmic
Antihistamines/Decongestant Combinations – Low Sedating (2nd Generation)
Antiparasitic Agents – Topical
Antiviral Agents – Herpes Oral
Antiviral Agents – Topical
Atopic Dermatitis Agents – Immunomodulators
Benzoyl Peroxide/Antibiotic Combinations
Beta-Adrenergic Agents – Long Acting
Beta-Adrenergic Agents – Nebulized
Beta-Adrenergic Agents – Short Acting
COPD Agents
Corticosteroids – Inhaled
Corticosteroids – Ophthalmic “Soft” Steroids
Corticosteroids – Topical
Corticosteroids and Rhinitis Agents – Intranasal
Cough and Cold Preparations
Epinephrine Self-Injectable Agents
Fluoroquinolones – Ophthalmic
Fluoroquinolones – Otic
Glaucoma Agents
Leukotriene Receptor Modifiers
Mast Cell Stabilizers – Ophthalmic
NSAIDs – Ophthalmic
Pancreatic Enzyme Agents
Psoriasis Agents – Oral
Psoriasis Agents – Topical
Retinoids – Topical
Ulcerative Colitis Agents – Oral
Ulcerative Colitis Agents - Rectal

Reports

Top 25 Drugs
Helpdesk Status Report
Logging Table
MO User Stats
New Drug Summary