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 |
|---|---|---|---|---|---|
| XELSTRYM | DEXTROAMPHETAMINE 18 MG/9 HR PATCH | 11/01/2022 | 12/16/2022 | PDL Product | April 2023 |
| XELSTRYM | DEXTROAMPHETAMINE 13.5 MG/9 HR PATCH | 11/01/2022 | 12/16/2022 | PDL Product | April 2023 |
| XELSTRYM | DEXTROAMPHETAMINE 9 MG/9 HR PATCH | 11/01/2022 | 12/16/2022 | PDL Product | April 2023 |
| XELSTRYM | DEXTROAMPHETAMINE 4.5 MG/9 HR PATCH | 11/01/2022 | 12/20/2022 | PDL Product | April 2023 |
| PEDMARK 12.5 GRAM/100 ML VIAL | SODIUM THIOSULFATE | 10/25/2022 | 12/06/2022 | Fiscal Edit | April 2023 |
| AUVELITY ER 45-105 MG TABLET | DETROMETHORPHAN HBR/BUPROPION | 10/25/2022 | 12/16/2022 | PDL Product | April 2023 |
| FRAGMIN 10,000 UNIT/4 ML VIAL | DALTEPARIN SODIUM PORCINE | 10/25/2022 | 12/06/2022 | PDL Product | April 2023 |
| ALLOPURINOL 200 MG TABLET | ALLOPURINOL | 10/25/2022 | 12/06/2022 | Fiscal Edit | April 2023 |
| VERKAZIA 0.1% EYE EMULSION | CYCLOSPORINE | 10/11/2022 | 12/06/2022 | PDL Product | April 2023 |
| FYLNETRA 6 MG/0.6 ML SYRINGE | PEGFILGRASTIM-PBBK | 10/02/2022 | 11/17/2022 | PDL Product | April 2023 |
| NEXICLON XR 0.17 MG TABLET | CLONIDINE HCL | 10/02/2022 | 11/22/2022 | PDL Product | April 2023 |
| ENTADFI 5-5 MG CAPSULE | FINASTERIDE/TADALAFIL | 10/02/2022 | 11/22/2022 | PDL Product | April 2023 |
| SKYSONA INFUSION BAG-CASSETTE | ELIVALDOGENE AUTOTEMCEL | 09/26/2022 | 11/10/2022 | Clinical Edit | December 2022 / January 2022 |
| ZYNTEGLO INFUSION BAG-CASSETTE | BETIBEGLOGENE AUTOTEMCEL | 09/26/2022 | 11/10/2022 | Open Access | December 2022 / January 2022 |
| CIMERLI 0.3 MG/0.05 ML VIAL | RANIBIZUMAB-EQRN | 09/26/2022 | 11/10/2022 | Open Access | December 2022 / January 2022 |