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 |
|---|---|---|---|---|---|
| ELEVIDYS 61.5 -62.4 KG(10MLX62) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| HULIO(CF) 40 MG/0.8 ML SYRINGE | ADALIMUMAB-AACF | 07/05/2023 | 08/15/2023 | PDL Product | January 2024 |
| ELEVIDYS 35.5 -36.4 KG(10MLX36) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 60.5-61.4 KG(10MLX61) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 16.5-17.4 KG(10MLX17) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 20.5 -21.4 KG(10MLX21) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 24.5-25.4 KG(10MLX25) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 28.5-29.4 KG(10MLX29) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| IDACIO(CF) 40 MG/0.8 ML SYRING | ADALIMUMAB-AACF | 07/05/2023 | 08/15/2023 | PDL Product | January 2024 |
| ELEVIDYS 66.5 -67.4 KG(10MLX67) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 40.5-41.4 KG(10MLX41) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 45.5-46.4 KG(10MLX46) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 50.5 -51.4 KG(10MLX51) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 22.5-23.4 KG(10MLX23) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 53.5-54.4 KG(10MLX54) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |