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 |
|---|---|---|---|---|---|
| HEMGENIX 71 -75 KG (10ML X15) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 76 -80 KG (10ML X16) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 81 -85 KG (10ML X17) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 86 -90 KG (10ML X18) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 171 -175 KG (10ML X35 | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 176 -180 KG (10ML X36) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edits | April 2023 |
| HEMGENIX 181 -185 KG (10ML X37) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 126 -130 KG (10ML X26) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| HEMGENIX 131 -135 KG (10ML X27) | ETRANACOGENE DEZAPARVOVEC - DRLB 1X10E13/ML KIT | 12/06/2022 | 01/17/2023 | Clinical Edit | April 2023 |
| ERMEZA 150 MCG/ML ORAL SOLUTION | LEVOTHYROXINE SODIUM | 11/29/2022 | 01/10/2023 | Fiscal Edit | April 2023 |
| METHYLPHENIDATE ER 45 MG TAB | METHYLPHENIDATE HCL | 11/22/2022 | 01/03/2022 | PDL Product | April 2023 |
| METHYLPHENIDATE ER 63 MG TAB | METHYLPHENIDATE HCL | 11/22/2022 | 01/03/2022 | PDL Product | April 2023 |
| LEUPROLIDE ACETATE 22.5 MG VIAL INTRAMUSC | LEUPROLIDE ACETATE | 11/22/2022 | 01/03/2023 | PDL Product | April 2023 |
| ROLVEDON 13.2 MG/0.6 ML SYRINGE | EFLAPEGRASTIM-XNST | 11/17/2022 | 01/03/2022 | PDL Product | April 2023 |
| NOXAFIL 300 MG POWDERMIX SUSP | POSACONAZOLE | 11/17/2022 | 12/27/2022 | PDL Product | April 2023 |