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.

ATTENTION: DRUG PRIOR AUTHORIZATION MEETING FOR MARCH 21, 2019 HAS BEEN CHANGED TO 615 HOWERTON, 2ND FLOOR, CONF ROOM 202. WE APOLOGIZE FOR ANY INCONVENIENCE. LIMITED SEATING, FIRST COME, FIRST SERVE

Preferred Drug Searchable Database

PDL List of Preferred and Non-Preferred Agents.

Issue Date Pharmacy Clinical Edit and PDL Description
02/08/16 15 Day Limitation Clinical Edit
11/06/18 15-Day Supply - Oral Oncology
04/05/18 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
07/12/18 Actinic Keratosis Agents – Topical PDL
02/01/19 ADHD Therapy
04/05/18 Alzheimer’s Agents & Cholinesterase Inhibitors PDL 
07/07/11 Ampyra
10/04/18 Amylin Analogs PDL
07/12/18 Androgenic Agents – Topical PDL
04/05/18 Antiemetics Agents PDL
01/10/19 Angiotensin Receptor Blocker Diuretic Combinations PDL
01/10/19 Angiotensin II Receptor-Calcium Channel Blocker Combinations PDL
01/10/19 Angiotensin Receptor Blockers PDL
01/10/19 Anticoagulants Agents: Oral and Subcutaneous PDL
01/10/19 Antiplatelet Agends PDL
10/04/18 AntiDiabetic Combinations: Oral and Injectable PDL
07/12/18 Antibiotic Agents – Inhaled PDL
07/12/18 Antihistamines – Intranasal PDL
07/12/18 2nd Generation Antihistamines PDL
07/12/18 2nd Generation Antihistamine – Decongestant (Low Sedating) Combinations PDL
10/04/18 Antihyperuricemic Agents PDL
07/12/18 Antifungal Agents – Topical PDL
07/12/18 Antiparasitic Agents – Topical PDL
07/12/18 Atopic Dermatitis Agents (Immunomodulators)
01/12/18 Atypical Antipsychotics
12/14/18 Benzoyl Peroxide-Antibiotic Combination PDL
07/12/18 Beta Adrenergic Agents Long Acting PDL
07/12/18 Beta Adrenergic Beta Blockers - Short Acting PDL
07/12/18 Beta Adrenergic Agents/Nebulized PDL
01/10/19 Beta Adrenergic Blockers and Diuretic Combinations PDL
10/31/17 BiDil® Tablets Clinical Edit
10/04/18 Bile Salts Agents PDL
10/04/18 Bone Deossification Suppression Agents PDL
09/01/17 Botulinum Toxin Clinical Edit
02/01/19 BPH Agents PDL (formerly Androgen Hormone Inhibitors)
01/23/19 Brand Over Generic
01/10/19 Calcium Channel Blockers (Dihydropyridines) PDL
01/10/19 Calcium Channel Blockers (Non-Dihydropyridines) PDL
06/21/18 CAR T Clinical Edit
10/04/18 Cephalosporin Antibiotics – Oral PDL
12/14/18 Corticosteroids and Rhinitis Agents – Intranasal PDL
01/10/19 Corticosteroids Oral – Inhaled PDL
10/26/18 COPD Anticholinergic Agents PDL
07/12/18 Corticosteroids-Topical PDL
07/01/13 Cough and Cold PDL
04/05/18 COX-2 Inhibitors PDL
10/04/18 Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL
02/28/19 Diabetic Supply Quantity Limit Fiscal Edit
01/10/19 Direct Renin Inhibitors and Combinations PDL
11/13/03 Dolgic LQ® (Acetaminophen/Butalbital/Caffeine)
10/04/18 DPP-IV Inhibitors PDL
10/04/18 Electrolyte Depleters PDL
05/16/07 Emsam®
01/31/19 Epinephrine Self-Injectable Agents PDL
01/19/06 Equetro®
08/01/17 Exondys 51® Clinical Edit
04/05/18 Fibromyalgia Agents PDL
10/04/18 Fluoroquinolones PDL
07/12/18 Fluoroquinolones – Ophthalmic PDL
07/12/18 Fluoroquinolones – Otic PDL
07/28/03 Forteo® (teriparatide injection / Parathyroid Hormone)
10/04/18 Gastrointestinal(GI) Antibiotics – Oral PDL
04/05/18 GI Motility Agents PDL
10/04/18 GLP-1 Receptor Agonists PDL
10/04/18 Growth Hormones and Growth Factors PDL
10/04/18 Hematopoietic Agents PDL
11/01/17 Hep C (HCV) Therapy
07/12/18 Herpes Antivirals – Oral PDL
12/11/03 H-Pylori Therapy
04/23/13 Human Papillomavirus Vaccines
03/01/19 Insulins Long Acting PDL
10/04/18 Insulins Mix PDL
10/04/18 Insulins PDL
10/04/18 Insulins Rapid Acting PDL
10/04/18 Intravaginal Antibiotics PDL
11/13/03 Klonopin Wafer® (clonazepam)
04/05/18 Long-Acting Opioids PDL
07/12/18 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
10/04/18 Macrolides - Adult PDL
10/04/18 Macrolides - Pediatric PDL
07/12/18 Mast Cell Stabilizers – Prostaglandin Agonists(Glaucoma Agents) PDL
08/25/10 Megestrol Acetate
10/04/18 Methotrexate Oral and Injectable PDL
04/04/19 Morphine Milligram Equivalent Accumulation
10/04/18 Multiple Sclerosis Agents PDL
02/01/19 Narcolepsy Inhibitors
04/05/18 Neuropathic Pain Agents PDL
01/04/18 Niacin Preparations PDL
04/05/18 Non-Ergot Dopamine Receptor Agonists PDL
01/26/12 Non-Oral Contraceptives Fiscal Edit
04/05/18 NSAID Agents PDL
07/12/18 NSAIDs – Ophthalmic PDL
05/03/07 Nubain®
05/23/13 Onfi (clobazam)
07/12/18 Antifungal (Onychomycosis – Candidiasis) Agents PDL
07/12/18 Antihistamines and Allergy Agents – Ophthalmic PDL
12/04/18 Opiate Dependence Agents PDL
03/01/18 Opioids, Short Acting Clinical Edits
03/01/18 Opioids, Combination Short-Acting Clinical Edit
10/04/18 Oral AntiDiabetic: Alpha - Glucosidase Inhibitors PDL
10/04/18 Oral AntiDiabetic: Biguanides PDL
10/04/18 Oral AntiDiabetic: Meglintinides PDL
10/04/18 Oral AntiDiabetic: Sulfonylureas 2nd Generation PDL
10/04/18 Oral AntiDiabetic: Thiazolidinediones PDL
01/31/05 Oxandrin®
07/12/18 Pancreatic Enzyme Agents PDL
10/04/18 Penicillins PDL
09/26/05 Prostin VR® Pediatric
01/10/19 Proton Pump Inhibitors PDL
07/12/18 Protaglandin Agonists (Glaucoma Agents) PDL
07/12/18 Psoriasis Agents – Topical PDL
11/12/10 Psychotropic Medications Polypharmacy
01/10/19 Pulmonary Arterial Hypertension (PAH) Agents (Inhaled and Injectable) PDL
01/10/19 Pulmonary Arterial Hypertension (PAH) Agents (Oral) PDL
07/07/11 Ranexa®
08/02/17 Respiratory Monoclonal Antibodies Clinical Edit
10/12/16 Ribavirins PDL
04/05/18 Sedative Hypnotics PDL
12/08/10 Selective Serotonin Reuptake Inhibitor (SSRI)
07/07/11 Selzentry® (Maraviroc)
07/03/12 Serotonin-Norepinephrine Reuptake Inhibitors (SNRI)
04/05/18 Skeletal Muscle RelaxantsPDL
10/04/18 Sodium - Glucose Co - Transporter 2 (SGLT2) PDL
08/01/17 Spinraza® Clinical Edit
01/10/19 Sympatholytic Agents PDL
09/16/10 Synagis (palivizumab)
10/04/18 Targeted Immune Modulators (Formerly Biologics - DMARDs) PDL
12/14/18 Tetracyclines PDL
07/12/18 Topical Antiviral Agents
07/12/18 Retinoids – Topical PDL
04/05/18 Tramadol-like Agents PDL
07/14/16 Transmucosal Immediate-Release Fentanyl (TIRF) Clinical Edit
01/16/04 Tricyclic Antidepressant Coordination of Care
07/12/18 Ulcerative Colitis Oral Agents PDL
01/17/19 Ulcerative Colitis-Rectal PDL
10/04/18 Urinary Tract Antispasmodics PDL
03/07/03 Voriconazole (Vfend) / Antifungal
11/13/03 Xanax XR® (Alprazolam)
11/13/03 Zometa® (zoledronic acid)
07/03/12 Zostavax Injection