Preferred Drug List & Utilization Managment Edits

Pharmacy Clinical Edits and Preferred Drug Lists

Pharmacy Program staff work with the MO HealthNet’s Pharmacy Advisory Committees, the University of Missouri-Kansas City School of Pharmacy Drug Information Center, the Oregon Evidence-Based Drug Research Consortium, and contractors to perform evidence-based reviews and develop product recommendations for utilization management (UM) and preferred drug list (PDL), which includes both drug and non-drug products. The clinical information is paired with a fiscal evaluation and developed into edit criteria. The UM program and PDL is vital to the utilization management strategy for point-of-sale and physician-administered drugs available via the Fee-For-Service benefit. An effectively and efficiently managed Pharmacy Program will provide savings and promote clinical care and prescribing habits based on best practices.

Implementation Schedule PDL/DSP Searchable Database Preferred/Non-Preferred Products Drug Prior Authorization Forms

Effective Date Pharmacy Clinical Edit and PDL Description Upcoming Policy Changes
15 Day Supply Oral Oncology Fiscal Edit
ACE Inhibitor/Calcium Channel Blocker Combinations PDL Edit
ACE Inhibitors and ACE Inhibitors/Diuretic Combinations PDL Edit
Acetaminophen Cumulative Dose Clinical Edit
Acne and Rosacea - Select Topical Agents Step Therapy Edit
Actinic Keratosis Agents, Topical PDL Edit Actinic Keratosis Agents Topical PDL 7-9-26
ADHD, Amphetamines Long Acting PDL Edit
ADHD Amphetamines Short Acting PDL Edit
ADHD, Methylphenidate Long Acting PDL Edit
ADHD, Methylphenidate Short Acting PDL Edit
ADHD, Non-Stimulants PDL Edit
Allergenics, Oral Clinical Edit
Alpelisib Clinical Edit
Alpha-Glucosidase Inhibitors PDL Edit
Alzheimer’s Agents, Acetylcholinesterase Inhibitors, N-Methyl-D-Aspartate Receptor Antagonists & Combinations PDL Edit
Ampyra Clinical Edit
Amylin Analogs PDL Edit
Androgenic Agents PDL Edit Androgenic Agents PDL 07-09-26
Angiotensin Receptor Blocker/Calcium Channel Blocker Combinations PDL Edit
Angiotensin Receptor Blockers and Angiotensin Receptor Blocker/Diuretic Combinations PDL Edit
Anti-Amyloid Monoclonal Antibody Clinical Edit
Anti-Migraine, Alternative Agents PDL Edit
Anti-Migraine, Serotonin (5-HT1) Receptor Agonists PDL Edit
Anti-Parkinsonism, MAO-B Inhibitors PDL Edit
Anti-Parkinsonism, Non-Ergot Dopamine Agonists PDL Edit
Antiandrogenic Agents PDL Edit
Antibiotics, Gastrointestinal (GI) Oral PDL Edit
Antibiotics, Inhaled PDL Edit Antibiotics Inhaled PDL 7-9-26
Antibiotics, Mupirocin Topical PDL Edit
Antibiotics, Vaginal PDL Edit
Anticholinergics, Long Acting Beta Adrenergic (LABA) Combinations PDL Edit Anticholinergics LABA Combo PDL 7-9-26
Anticholinergics, Long Acting Beta Adrenergics (LABA)/ Inhaled Corticosteroid (ICS) Combinations PDL Edit Anticholinergics LABA ICS Combo PDL 7-9-26
Anticholinergics, Long Acting Inhaled PDL Edit Anticholinergics Long Acting Inhaled PDL 7-9-26
Anticholinergics, Short Acting and Combinations Inhaled PDL Edit Anticholinergics Short Acting and Combo Inhaled PDL 7-9-26
Anticoagulants, Oral and Subcutaneous PDL Edit
Anticonvulsants, Dravet Syndrome PDL Edit
Anticonvulsants, Rescue Agents PDL Edit
Antiemetics, 5-HT3, NK1 and Other Select Non-Injectables PDL Edit
Antiemetics, 5-HT3 and NK1 Injectables PDL Edit
Antifungals (Onychomycosis/Candidiasis), Oral PDL Edit Antifungals Oral PDL 7-9-26