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
ADLARITY 10 MG/DAY PATCH DONEPEZIL HCL 06/05/2022 08/02/2022 PDL Edit September 2022 / October 2022
MOUNJARO 7.5 MG/0.5 ML PEN TIRZEPATIDE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
LYVISPAH 20 MG GRANULE PACKET BACLOFEN 05/23/2022 08/02/2022 PDL Edit September 2022 / October 2022
MOUNJARO 12.5 MG/0.5 ML PEN TIRZEPATIDE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
MOUNJARO 5 ML/0.5 ML PEN TIRZEPATIDE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
MOUNJARO 2.5 MG/0.5 ML PEN TIRZEPATIDE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
LYVISPAH 10 MG GRANULE PACKET BACLOFEN 05/23/2022 08/11/2022 Clinical Edit September 2022 / October 2022
MOUNJARO 10 MG/0.5 ML PEN TIRZEPATIDE 05/23/2022 08/02/2022 PDL Edit September 2022 / October 2022
LYVISPAH 5 MG GRANULE PACKET BACLOFEN 05/23/2022 08/02/2022 PDL Edit September 2022 / October 2022
MOUNJARO 15 MG/0.5 ML PEN TIRZEPATIDE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
RADICAVA ORS 105 MG/5 ML SUSPENSION EDARAVONE 05/23/2022 07/19/2022 PDL Edit September 2022 / October 2022
EPSOLAY 5% CREAM PUMP BENZOYL PEROXIDE 05/16/2022 07/19/2022 Open Access September 2022 / October 2022
NORLIQVA 1 MG/ ML SOLUTION AMLODIPINE BESYLATE 05/02/2022 07/19/2022 Therapy Edit September 2022 / October 2022
VONJO 100 MG CAPSULE PACRITINIB CITRATE 04/18/2022 07/19/2022 Clinical Edit September 2022 / October 2022
VIJOICE 50 MG TABLET ALPELISIB 04/18/2022 07/21/2022 Clinical Edit September 2022 / October 2022