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.

Quarterly Preferred Drug List Changes

Grandfathering Recommendations

Opioid Prior Authorization Process
Opioid Prior Authorization Process for Prescribers
Opioid Prior Authorization Process for Pharmacy
Opioid Prior Authorization Form

Preferred Drug Searchable Database

PDL List of Preferred and Non-Preferred Agents.

Issue Date Pharmacy Clinical Edit and PDL Description
08/15/19 15 Day Limitation Fiscal Edit
11/06/18 15-Day Supply - Oral Oncology
07/18/19 5-HTI Serotonin Receptor Agonists (Triptans) PDL
01/10/19 ACE Inhibitors PDL
01/10/19 ACE Inhibitors/Calcium Channel Blocker Combinations PDL
01/10/19 Ace Inhibitors/Diuretic Combinations PDL
07/11/19 Actinic Keratosis Agents – Topical PDL
10/03/19 ADHD Therapy
04/04/19 Alzheimer’s Agents & Cholinesterase Inhibitors PDL 
07/07/11 Ampyra
10/03/19 Amylin Analogs PDL
07/11/19 Androgenic Agents – Topical PDL
01/10/19 Angiotensin Receptor Blocker Diuretic Combinations PDL
01/10/19 Angiotensin Receptor Blockers PDL
01/10/19 Angiotensin II Receptor-Calcium Channel Blocker Combinations PDL
07/11/19 Antibiotic Agents – Inhaled PDL
01/10/19 Anticoagulants Agents: Oral and Subcutaneous PDL
10/03/19 AntiDiabetic Combinations: Oral and Injectable PDL
10/17/19 Antiemetics –5-HT3 Agents & Other PDL
04/04/19 Antiemetics –THC Derivative Agents PDL
11/07/19 Antifungal Agents – Topical PDL
07/11/19 Antifungal (Onychomycosis – Candidiasis) Agents PDL
07/11/19 Antihistamine Decongestant Combos
07/11/19 Antihistamines – Intranasal PDL
07/11/19 Antihistamines - Low Sedating
07/11/19 Antihistamines - Ophthalmic
10/03/19 Antihyperuricemic Agents PDL
10/03/19 Antiparasitic Agents – Topical PDL
04/04/19 Anti-Parkinsonism MAOB Inhibitors PDL
01/10/19 Antiplatelet Agents
06/13/19 Antipsychotics– 2nd Generation (Atypicals) PDL
07/11/09 Antivirals - Topical PDL
08/08/19 Atopic Dermatitis Agents (Immunomodulators)
10/10/19 Benzodiazepines (Select Oral) Clinical Edit
07/11/19 Benzoyl Peroxide-Antibiotic Combination PDL
07/11/19 Beta Adrenergic Agents Long Acting PDL
07/11/19 Beta Adrenergic Agents/Nebulized PDL
07/11/19 Beta Adrenergic Beta Blockers - Short Acting PDL
01/10/19 Beta Adrenergic Blockers and Diuretic Combinations PDL
10/31/17 BiDil® Tablets Clinical Edit
10/03/19 Bile Salts Agents PDL
10/03/19 Bone Ossification Suppression Agents
10/24/19 Botulinum Toxin Clinical Edit
10/03/19 BPH Agents PDL (formerly Androgen Hormone Inhibitors)
10/17/19 Brand Over Generic
10/17/19 Butalbital Combo Clinical Edit
01/10/19 Calcium Channel Blockers (Dihydropyridines) PDL
01/10/19 Calcium Channel Blockers (Non-Dihydropyridines) PDL
06/21/18 CAR T Clinical Edit
10/03/19 Cephalosporin Antibiotics – Oral PDL
08/01/19 CGRP Inhibitors
10/24/19 Clobazam Agents Clinical Edit
10/03/19 Colony Stimulating Factors
07/11/19 COPD Anticholinergic Agents PDL
12/03/18 Corlanor Clinical Edit
07/11/19 Corticosteroids Oral – Inhaled PDL
07/11/19 Corticosteroids - Intranasal PDL
07/11/19 Corticosteroids - Ophthalmic PDL
07/11/19 Corticosteroids-Topical PDL
07/12/19 Cough and Cold PDL
04/04/19 COX-2 Inhibitors PDL
10/03/19 Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL
04/11/19 Crysvita Clinical Edit
08/01/19 Diabetic Supply Quantity Limit Fiscal Edit
01/10/19 Direct Renin Inhibitors and Combinations PDL
11/13/03 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
11/07/19 Dose Optimization Fiscal Edit
10/03/19 DPP-IV Inhibitors PDL
10/03/19 Electrolyte Depleters PDL
10/03/19 Electrolyte Depleters – Potassium Lowering Agents PDL
05/16/07 Emsam®
12/03/18 Entresto Clinical Edit
10/24/19 Epidiolex Clinical Edit
07/11/19 Epinephrine Self-Injectable Agents PDL
06/20/19 Equetro Clinical Edit®
10/03/19 Erythropoiesis Stimulating Agents PDL
08/01/17 Exondys 51® Clinical Edit
08/08/19 Fibromyalgia Agents PDL
10/03/19 Fluoroquinolones PDL
07/11/19 Fluoroquinolones – Ophthalmic PDL
07/11/19 Fluoroquinolones – Otic PDL
07/28/03 Forteo® (teriparatide injection / Parathyroid Hormone)
05/23/19 Galafold™ (migalastat) Clinical Edit
10/17/19 Gamifant Clinical Edit
10/03/19 Gastrointestinal(GI) Antibiotics – Oral PDL
04/04/19 GI Motility Agents PDL
10/24/19 Glaucoma Agents PDL
10/03/19 GLP-1 Receptor Agonists PDL
10/03/19 Growth Hormones and Growth Factors PDL
10/03/19 Hep C (HCV) Therapy
08/12/19 Hereditary Angioedema Treatment Agents PDL
07/11/19 Herpes Antivirals – Oral PDL
08/01/19 Hospice Fiscal Edit
10/03/19 Insulins Long Acting PDL
10/03/19 Insulins Mix PDL
10/03/19 Insulins-Non-Ananlog PDL
10/03/19 Insulins Rapid Acting PDL
04/11/19 Jynarque Clinical Edit
07/11/19 Leukotriene Modifiers PDL
01/10/19 Lipotropic Agents: Homozygous FamilialHyperchloesterolemia PDL
01/10/19 Lipotropic Agents: Niacin Derivatives PDL
01/10/19 Lipotropic Agents: Proprotein Convertase SubtilisinKexin Type 9 (PCSK9) Binder PDL
01/10/19 Lipotropic Agents: Statins (HMG Co-A ReductaseInhibitors) and Combination Products PDL
01/10/19 Lipotropic Agents: Triglyceride Lowering Agents PDL
04/18/19 Luxturna Clinical Edit
10/03/19 Macrolides PDL
07/11/19 Mast Cell Stabilizers - Ophthalmic PDL
04/18/19 Megestrol Acetate
10/03/19 Methotrexate Products
04/04/19 Morphine Milligram Equivalent Accumulation
10/03/19 Multiple Sclerosis Agents PDL
02/01/19 Narcolepsy Inhibitors
04/04/19 Neuropathic Pain Agents PDL
08/22/19 Nocturnal Polyuria Clinical Edit
04/04/19 Non-Ergot Dopamine Receptor Agonists PDL
09/19/19 Non-Oral Contraceptives Fiscal Edit
04/04/19 NSAID Agents PDL
07/11/19 NSAIDs – Ophthalmic PDL
05/03/07 Nubain®
10/10/19 Opioid Dependence Agents PDL
04/04/19 Opioid Emergency Reversal Agents PDL
10/03/19 Opioid - Long Acting PDL
04/11/19 Opioids, Combination Short-Acting Clinical Edit
05/16/19 Opioids, Short Acting Clinical Edits
10/03/19 Oral AntiDiabetic: Alpha - Glucosidase Inhibitors PDL
10/03/19 Oral AntiDiabetic: Biguanides PDL
10/03/19 Oral AntiDiabetic: Meglintinides PDL
10/03/19 Oral AntiDiabetic: Thiazolidinediones PDL
07/24/19 Orilissa Clinical Edit
01/31/05 Oxandrin®
10/17/19 Oxervate Clinical Edit
04/18/19 Palynziq Clinical Edit
07/11/19 Pancreatic Enzyme Agents PDL
10/03/19 Penicillins PDL
05/16/19 Polyneuropathy hATTR Clinical Edit
01/10/19 Proton Pump Inhibitors PDL
07/11/19 Psoriasis Agents - Oral PDL
07/11/19 Psoriasis Agents – Topical PDL
08/05/19 Psychotropic Medications Polypharmacy
08/22/19 Pulmonary Arterial Hypertension (PAH) Agents (Inhaled and Injectable) PDL
08/01/19 Pulmonary Arterial Hypertension (PAH) Agents (Oral) PDL
07/07/11 Ranexa®
10/17/19 Respiratory Monoclonal Antibodies PDL
07/11/19 Retinoids – Topical PDL
10/12/16 Ribavirins PDL
10/03/19 Second Generation Sulfonylureas PDL
08/08/19 Sedative Hypnotics PDL
06/20/19 Selzentry® (Maraviroc)
04/04/19 Skeletal Muscle Relaxants PDL
05/02/19 SNRI Clinical Edit
10/03/19 Sodium - Glucose Co - Transporter 2 (SGLT2) PDL
08/01/17 Spinraza® Clinical Edit
09/26/19 SSRI Clinical Edit
08/29/19 Sympatholytic Agents PDL
10/10/19 Synagis Clinical Edit
08/22/19 Systemic Antifungals Clinical Edit
10/03/19 Targeted Immune Modulators (Formerly Biologics - DMARDs) PDL
10/03/19 Tetracyclines PDL
10/03/19 ThromobocytopeniaTreatment Agents PDL
04/04/19 Tramadol - like Agents PDL
08/29/19 Ulcerative Colitis Oral Agents PDL
07/11/19 Ulcerative Colitis - Rectal PDL
10/03/19 Urinary Tract Antispasmodics PDL
10/03/19 Vaginal Antibiotics PDL
03/07/03 Voriconazole (Vfend) / Antifungal
11/13/03 Zometa® (zoledronic acid)