Drugs with Coverage Limitations and New Drug Review header

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(link sends email) or call 573-751-6963. 

Trade Name Generic Name Date Review Began Date Review Completed Conclusion Advisory Committee Month
PIRFENIDONE 534 MG TABLET PIRFENIDONE 08/22/2022 10/11/2022 Open Access December 2022 / January 2022
XIPERE 40 MG/ML VIAL TRIAMCINOLONE ACETONIDE 08/22/2022 10/18/2022 PDL Edit December 2022 / January 2022
VIVJOA 150 MG CAPSULE OTESECONAZOLE 08/22/2022 10/06/2022 PDL Product December 2022 / January 2022
AEMCOLO DR 194 MG TABLET RIFAMYCIN 08/15/2022 10/11/2022 Fiscal Edit December 2022 / January 2022
PEGASYS 180 MCG/0.5 ML VIAL PEGINTERFERON ALFA-2A 08/08/2022 09/20/2022 Fiscal Edit December 2022 / January 2022
PEGASYS 180 MCG/0.5 ML SYRINGE PEGINTERFERON ALFA-2A 08/08/2022 09/20/2022 Clinical Edit December 2022 / January 2022
QUETIAPINE 150 MG TABLET QUETIAPINE 08/08/2022 09/20/2022 PDL Product December 2022 / January 2022
CAPLYTA 10.5 MG CAPSULE LUMATEPERONE TOSYLATE 07/31/2022 09/20/2022 Fiscal Edit December 2022 / January 2022
TASCENSO ODT 0.25 MG TABLET FINGOLIMOD LAURYL SULFATE 07/31/2022 09/13/2022 Step Therapy Edit December 2022 / January 2022
INJECTAFER 100 MG/2 ML VIAL FERRIC CARBOXYMALTOSE 07/31/2022 09/13/2022 Fiscal Edit December 2022 / January 2022
IGALMI 180 MCG SL FILM DEXMEDETOMIDINE HCL 07/31/2022 09/13/2022 Fiscal Edit December 2022 / January 2022
IGALMI 120 MCG SL FILM DEXMEDETOMIDINE HCL 07/31/2022 09/13/2022 Clinical Edit December 2022 / January 2022
CAPLYTA 21 MG CAPSULE LUMATEPERONE TOSYLATE 07/31/2022 09/13/2022 Clinical Edit December 2022 / January 2022
SUSVIMO 10 MG/0.1 ML KIT RANIBIZUMAB/INIT FILL NEEDLE 07/24/2022 09/13/2022 PDL Product December 2022 / January 2022
VENLAFAXINE BES ER 112.5 MG TB VENLAFAXINE BESYLATE 07/24/2022 09/06/2022 Open Access December 2022 / January 2022