Drugs with Coverage Limitations and New Drug Review
Please Note:
- Date Review Completed and Conclusion columns are blank for those products currently undergoing review. Details will be updated as efficiently as possible following initial review.
- Conclusions are based upon decisions made at the time reviews are completed; historical information is not updated. Product management is subject to change based on new clinical evidence, provider/public feedback, advisory committee recommendations, financial considerations, etc.
- This contains approximately one year of New Drug details.
- Advisory Meeting Month is the month this recommendation will be presented at the quarterly Drug Prior Authorization Committee (DPAC) and Drug Utilization Review (DUR) Board meetings. For meeting dates, please see the MO HealthNet Calendar of Events. Certain agents may also be discussed at the quarterly Rare Disease Advisory Council meeting immediately prior to their presentation at their designated DPAC/DUR meeting.
For more information on this process please view the New Drug Review Process or contact the MO HealthNet Pharmacy Program at MHD.PharmacyAdmin@dss.mo.gov or call 573-751-6963.
| Trade Name | Generic Name | Date Review Began | Date Review Completed | Conclusion | Advisory Committee Month |
|---|---|---|---|---|---|
| AUSTEDO XR 12 MG TABLET | DEUTETRABENAZINE | 04/25/2023 | 06/06/2023 | PDL Product | October 2023 |
| AUSTEDO XR 6 MG TABLET | DEUTETRABENAZINE | 04/25/2023 | 06/06/2023 | PDL Product | October 2023 |
| MIRCERA 120 MCG/0.3 ML SYRINGE | METHOXY PEG-EPOETIN BETA | 04/25/2023 | 06/06/2023 | PDL Product | October 2023 |
| CITRANATAL MEDLEY SOFTGEL | MV-MIN102/IRON CARB,FUM/FA/DHA | 04/11/2023 | 05/23/2023 | Fiscal Edit | October 2023 |
| GOHIBIC 200 MG/20 ML VL (EUA) | VILOBELIMAB | 04/11/2023 | 05/23/2023 | Fiscal Edit | October 2023 |
| ZOLGENSMA 18.1-18.5 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| TIROSINT 37.5 MCG CAPSULE | LEVOTHYROXINE SODIUM | 04/04/2023 | 05/16/2023 | Fiscal Edit | October 2023 |
| ZOLGENSMA 19.6-20.0 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 17.1-17.5 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 16.1-16.5 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 14.6-15.0 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 15.6-16.0 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 19.1-19.5 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 15.1-15.5 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |
| ZOLGENSMA 18.6-19.0 KG KIT | ONASEMNOGENE ABEPARVOVECXIOI | 04/04/2023 | 05/16/2023 | Clinical Edit | October 2023 |