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 32.5 -33.4 KG(10MLX33) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 18.5-19.4 KG(10MLX19) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 29.5-30.4 KG(10MLX30) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 12.5-13.4 KG(10MLX13) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 47.5 -48.4 KG(10MLX48) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| CYLTEZO(CF) 40 MG/0.8 ML SYRNG | ADALIMUMAB | 07/05/2023 | 08/15/2023 | PDL Product | January 2024 |
| ELEVIDYS 41.5-42.4 KG(10MLX42) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 203 |
| ELEVIDYS 54.5-55.4 KG(10MLX55) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 10-10.4 KG (10ML X10) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 49.5 -50.4 KG(10MLX50) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 36.5-37.4 KG(10MLX37) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 63.5 -64.4 KG(10MLX64) | DELANDISTROGENE MOXEPARVC - ROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| HULIO(CF) 20 MG/0.4 ML SYRINGE | ADALIMUMAB-AACF | 07/05/2023 | 08/15/2023 | PDL Product | January 2024 |
| ELEVIDYS 44.5-45.4 KG(10MLX45) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 2024 |
| ELEVIDYS 57.5-58.4 KG(10MLX58) | DELANDISTROGENE MOXEPARVCROKL | 07/05/2023 | 08/15/2023 | Clinical Edit | January 203 |