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
02/06/20 15 Day Limitation Fiscal Edit
11/06/18 15-Day Supply - Oral Oncology
11/14/19 5-HTI Serotonin Receptor Agonists (Triptans) PDL
01/09/20 ACE Inhibitors and ACE Inhibitors Diuretic Combinations PDL
01/09/20 ACE Inhibitors/Calcium Channel Blocker Combinations PDL
07/11/19 Actinic Keratosis Agents – Topical PDL
01/09/20 ADHD Amphetamines – Long Acting
ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old
Adult ADD/ADHD Prior Authorization Form
01/09/20 ADHD Amphetamines – Short Acting
ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old
Adult ADD/ADHD Prior Authorization Form
01/09/20 ADHD Methylphenidate – Long Acting
ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old
Adult ADD/ADHD Prior Authorization Form
01/09/20 ADHD Methylphenidate – Short Acting
ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old
Adult ADD/ADHD Prior Authorization Form
01/09/20 ADHD Non-Stimulant Agents
ADHD Medication Prior Authorization Form - Children Less Than 6 Years Old
Adult ADD/ADHD Prior Authorization Form
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
01/09/20 Angiotensin Receptor Blockers and Angiotensin Receptor Blocker/Diuretic Combinations PDL
01/09/20 Angiotensin Receptor Blocker-Calcium Channel Blocker Combinations PDL
07/11/19 Antibiotic Agents – Inhaled PDL
01/09/20 Anticoagulants Agents: Oral and Subcutaneous PDL
10/03/19 AntiDiabetic Combinations: Oral and Injectable PDL
1/17/20 Antiemetics-5-HT3, NK1 & Other Agents 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
01/09/20 Antiplatelet Agents
06/13/19 Antipsychotics – 2nd Generation (Atypicals) Reference Drug List
Atypical Antipsychotic Prior Authorization Form - Children Less Than 9 Years Old
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
03/20/20 Beta Adrenergic Beta Blockers - Short Acting PDL
01/09/20 Beta Adrenergic Blockers and Beta Adrenergic Blockers/Diuretic Combinations PDL
02/13/20 BiDil® Tablets Clinical Edit
10/03/19 Bile Salts Agents PDL
02/06/20 Biosimilar vs Reference Products Fiscal Edit
10/03/19 Bone Ossification Suppression Agents
02/13/20 Botulinum Toxin Clinical Edit
10/03/19 BPH Agents PDL (formerly Androgen Hormone Inhibitors)
03/20/20 Brand Over Generic
10/17/19 Butalbital Combo Clinical Edit
01/09/20 Calcium Channel Blockers (Dihydropyridines) PDL
01/09/20 Calcium Channel Blockers (Non-Dihydropyridines) PDL
06/21/18 Car T Cell 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
04/02/20 Continuous Glucose Monitors (CGMs) Clinical Edit  Continuous Glucose Monitoring Device Prior Authorization
07/11/19 COPD Anticholinergic Agents PDL
12/03/18 Corlanor Clinical Edit
03/05/20 Corticosteroids Oral – Inhaled PDL
07/11/19 Corticosteroids - Intranasal PDL
07/11/19 Corticosteroids - Ophthalmic PDL
01/23/20 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
01/30/20 Diacomit Clinical Edit
01/09/20 Direct Renin Inhibitors and Combinations PDL
11/13/03 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
03/17/20 Dose Optimization Fiscal Edit
10/03/19 DPP-IV Inhibitors PDL
01/09/20 Dry Eye Disease Agents PDL
02/06/20 Duchenne Muscular Dystrophy (DMD) Clinical Edit
10/03/19 Electrolyte Depleters PDL
03/05/20 Electrolyte Depleters – Potassium Lowering Agents PDL
02/13/2020 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
03/05/20 Fluoroquinolones – Ophthalmic PDL
11/14/19 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
01/09/20 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
01/09/20 Homozygous Familial Hyperchloesterolemia (HFHC) Products PDL
08/01/19 Hospice Fiscal Edit
10/03/19 Insulins Long Acting PDL
10/03/19 Insulins Mix PDL
01/09/20 Insulins-Non-Analog PDL
10/03/19 Insulins Rapid Acting PDL
04/11/19 Jynarque Clinical Edit
01/30/20 Lambert-Eaton Myasthenic Syndrome (LEMS) Clinical Edit
07/11/19 Leukotriene Modifiers 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
12/05/19 Multiple Sclerosis Agents PDL
02/20/20 Narcolepsy Inhibitors
04/04/19 Neuropathic Pain Agents PDL
01/09/20 Niacin Derivatives
08/22/19 Nocturnal Polyuria Clinical Edit
04/04/19 Non-Ergot Dopamine Receptor Agonists PDL
11/21/19 Non-Oral Contraceptives Fiscal Edit
03/12/20 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
01/09/20 Opioid - Long Acting PDL
Opioid Prior Authorization Form
04/11/19 Opioids, Combination Short-Acting Clinical Edit
Opioid Prior Authorization Form
05/16/19 Opioids, Short Acting Clinical Edits
Opioid Prior Authorization Form
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
02/20/20 Oxandrin® Clinical Edit
10/17/19 Oxervate Clinical Edit
04/18/19 Palynziq Clinical Edit
07/11/19 Pancreatic Enzyme Agents PDL
02/06/20 Parathyroid Hormone and Bone Resorption Suppression Related Agents Clinical Edit
10/03/19 Penicillins PDL
01/09/20 Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Binder PDL
01/09/20 Proton Pump Inhibitors PDL
07/11/19 Psoriasis Agents - Oral PDL
02/06/20 Psoriasis Agents – Topical PDL
02/06/20 Psychotropic Medications Polypharmacy Clinical Edit
01/09/20 Pulmonary Arterial Hypertension (PAH) Agents (Inhaled and Injectable) PDL
01/09/20 Pulmonary Arterial Hypertension (PAH) Agents – Oral Endothelin Receptor Antagonists (ETRAs)
01/09/20 Pulmonary Arterial Hypertension (PAH) Agents – Oral Phosphodiesterase-5 (PDE5)
01/09/20 Pulmonary Arterial Hypertension (PAH) Agents – Oral Prostacyclin Pathway Agonist
02/20/20 Ranexa® Clinical Edit
11/14/19 Respiratory Monoclonal Antibodies PDL
07/11/19 Retinoids – Topical PDL
10/12/16 Ribavirins PDL
10/03/19 Second Generation Sulfonylureas PDL
04/02/20
07/09/20
Sedative Hypnotics PDL
Sedative Hypnotics PDL
06/20/19 Selzentry® (Maraviroc)
12/12/19 Skeletal Muscle Relaxants PDL
01/23/20 SNRI Clinical Edit
10/03/19 Sodium - Glucose Co - Transporter 2 (SGLT2) PDL
01/30/20 Spinraza® Clinical Edit
01/23/20 SSRI Clinical Edit
01/09/20 Statins (HMG Co-A Reductase Inhibitors) and Combination Products PDL
01/09/20 Sympatholytic Agents PDL
02/27/20 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
02/27/20 Transthyretin-Mediated Amyloidosis (ATTR) Clinical Edit
01/09/20 Triglyceride Lowering Agents PDL
12/08/19 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
01/30/20 Zolgensma Clinical Edit
02/27/20 Zometa® (zoledronic acid)