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
GI Motility Agents, Chronic PDL Edit
Givlaari Clinical Edit
Glaucoma Agents PDL Edit
Glucagon Agents PDL Edit
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists Indicated for Obesity PDL Edit
Growth Hormone Agents, Somatropin Short Acting PDL Edit || Growth Hormone Somatropin Agents Prior Authorization
Growth Hormone Releasing Factors, Select Agents PDL Edit
Growth Hormone Somatropin Agents, Long-Acting PDL Edit
HBV Nucleotide Analog Reverse Transcriptase Inhibitors Fiscal Edit
Hemgenix Clinical Edit
Hemophilia Gene Therapy Agents Clinical Edit
Hepatitis C Agents PDL Edit || Hepatitis C Treatment Prior Authorizaton
Hereditary Angioedema Agents PDL Edit
High Risk Therapy Clinical Edit
Homozygous Familial Hypercholesterolemia (HoFH) Agents PDL Edit
Hospice Fiscal Edit
Imcivree Clinical Edit
Immunoglobulins (IVIG/SCIG) Clinical Edit
Inflammatory Bowel Disease Agents, Oral PDL Edit
Inflammatory Bowel Disease Agents, Rectal PDL Edit
Inhaler Spacers Excessive Therapy Edit
Insulin Pumps – Tubeless Clinical Edit
Insulin, Long Acting PDL Edit
Insulin, Mixed PDL Edit
Insulin, Non-Analogs PDL Edit
Insulin, Rapid Acting PDL Edit
Iron – Injectable Step Therapy Edit
Isturisa Clinical Edit
Joenja Clinical Edit
Journavx Clinical Edit
Kebilidi Clinical Edit
Keratoconjunctivitis Agents PDL Edit
Koselugo Clinical Edit
Lambert-Eaton Myasthenic Syndrome (LEMS) Clinical Edit
Lenmeldy Clinical Edit
Leukotriene Receptor Modifiers PDL Edit
Lipotropics, Alternative Agents PDL Edit
Luteinizing Hormone Releasing Hormone (LHRH)/Gonadotropin Releasing Hormone (GnRH) Agents, Non-Oral PDL Edit
Luteinizing Hormone Releasing Hormone (LHRH)/Gonadotropin Releasing Hormone (GnRH) Agents, Oral PDL Edit