MO HealthNet is continuing the state specific Preferred Drug List and
Clinical Edit processes. The following is a listing of therapeutic classes that
have been implemented. Please see the implementation schedule
for proposed implementation dates for additional classes.
Table of clinical edit documents listed by issue date and description. The
description is linked to the file. All files are in PDF.
| Issue Date |
Pharmacy Clinical Edit and PDL Description |
| Jun 05, 2009 |
15
Day Limitation |
| Jun 05, 2009 |
5-HT1
Agonist (Triptan) Therapy-PDL |
| Aug 12, 2009 |
5HT3
Receptor Antagonists-PDL |
| Aug 26, 2009 |
ACE
Inhibitors-PDL |
| Feb 13, 2009 |
ACE
Inhibitors/Calcium Channel Blocker Combinations-PDL |
| Mar 24, 2003 |
Actiq
Lozenges |
| Aug 26, 2008 |
ADHD
Therapy |
| Jul 07, 2003 |
Alinia
(Nitazoxanide) / antiparasitic/antimicrobial) |
| Feb 17, 2009 |
Alpha-GlucosidaseInhibitors-PDL |
| Feb 17, 2009 |
Alzheimer's Agents (Cholinesterase Inhibitors) -PDL |
| Jul 21, 2008 |
Amylin
Analogs-PDL |
| Dec 19, 2006 |
Amitiza® |
| Jul 21, 2008 |
Androgen Hormone Inhibitor-PDL |
| Apr 20, 2009 |
Angiotensin
II Receptor Blocker Diuretic Combinations-PDL |
| Feb 13, 2009 |
Angiotensin
II Receptor Blockers-PDL |
| Jul 29, 2003 |
Antibiotic
RTU Pack |
| Mar 29, 2004 |
Antiplatelet
Step Therapy Edit |
| Aug 12, 2009 |
Beta
Adrenergic Agents Long Acting - PDL |
| Aug 12, 2009 |
Beta
Adrenergic Agents Short Acting - PDL |
| Aug 12, 2009 |
Beta
Adrenergic Agents/Nebulized - PDL |
| Jul 15, 2008 |
Beta
Adrenergic Blockers- PDL |
| Nov 09, 2006 |
BiDil® Tablets |
| Feb 17, 2009 |
Biguanides-PDL |
| Feb 17, 2009 |
Bone
Deossification Suppression Agents - PDL |
| Apr 29, 2005 |
Botulinum
Toxin Type A (Botox) |
| Jul 15, 2008 |
Calcium
Channel Blockers (DHP)-PDL |
| Jul 21, 2008 |
Calcium
Channel Blockers (nonDHP)-PDL |
| Sep 30, 2008 |
Calcium Channel Blockers/ARBS-PDL |
| Jul 29, 2003 |
Cold
Sore Treatment Fiscal Edit |
| Nov 17, 2005 |
Combunox® Tablets |
| Aug 12, 2009 |
COPD
Anticholinergics -PDL |
| Jul 21, 2008 |
COX-2
Inhibitors -PDL |
| Feb 17, 2009 |
Direct Renin Inhibitors -PDL |
| Jun 05, 2009 |
Disease-Modifying
AntiRheumatic Drug (DMARD) - PDL |
| Nov 13, 2003 |
Dolgic
LQ® (Acetaminophen/Butalbital/Caffeine) |
| Jul 21, 2008 |
DPP-IV
Inhibitors-PDL |
| Feb 17, 2009 |
Electrolyte
Depleters-PDL |
| May 16, 2007 |
Emsam® |
| Aug 12, 2009 |
Epoetins |
| Jan 19, 2006 |
Equetro® |
| Jul 29, 2003 |
Fluconazole
(Diflucan) |
| Feb 17, 2009 |
FluoroQuinolones-Oral-PDL |
| Jul 28, 2003 |
Forteo® (teriparatide
injection / Parathyroid Hormone) |
| Apr 04, 2007 |
Gardasil® Injection |
| Jul 07, 2003 |
Geodon
for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible |
| Jul 21, 2008 |
GLP-1
Receptor Agonists -PDL |
| Jul 15, 2009 |
Growth Hormones-PDL |
| Jul 07, 2003 |
H2
Antagonists |
| Jul 21, 2008 |
Hepatitis
C Therapy-PDL |
| Feb 17, 2009 |
Herpes
Antivirals-PDL |
| Aug 12, 2009 |
HMG-Co
A reductase inhibitors (statins) -PDL |
| Dec 11, 2003 |
H-Pylori
Therapy |
| Nov 16, 2009 |
Inhaled
Corticosteroids - PDL |
| Aug 12, 2009 |
Insulin
Mix-PDL |
| Aug 12, 2009 |
Insulin
Rapid Acting-PDL |
| Aug 12, 2009 |
Insulins-PDL |
| Aug 12, 2009 |
Insulins
Long Acting-PDL |
| Jun 25, 2009 |
Intranasal Antihistamines-PDL |
| Feb 17, 2009 |
Intranasal
Steroids - PDL |
| Jun 18, 2009 |
Intravaginal
Antibiotics - PDL |
| Nov 13, 2003 |
Klonopin
Wafer® (clonazepam) |
| Nov 07, 2003 |
Lactulose
Step Therapy Edit |
| Feb 17, 2009 |
Leukotriene-PDL |
| Apr 29, 2008 |
Lyrica® |
| Jul 15, 2009 |
Low Molecular Weight Anticoagulants |
| Feb 17, 2009 |
Macrolides-PDL |
| Feb 17, 2009 |
Meglintinides
- PDL |
| Nov 03, 2004 |
Methadone |
| Nov 12, 2009 |
Miralax |
| Feb 17, 2009 |
Multiple
Sclerosis Agents-PDL |
| Feb 17, 2009 |
Narcotics,
Long Acting - PDL |
| Jun 18, 2009 |
Niacin
Preparations - PDL |
| Jul 15, 2009 |
Non-Ergot Dopamine Receptor Agonists-PDL |
| Feb 17, 2009 |
Non-Sedating
Antihistamines-PDL |
| Nov 19, 2004 |
NSAID
Step Therapy Edit |
| May 03, 2007 |
Nubain® |
| Jul 15, 2008 |
Onychomycosis
Antifungal Agents-PDL |
| Jun 20, 2007 |
Opana® Immediate-Release
Tablets |
| Feb 17, 2009 |
Ophthalmic
Antihistamines-PDL |
| Feb 17, 2009 |
Ophthalmic
Mast Cell Stabilizers-PDL |
| Jul 15, 2009 |
Ophthalmic
NSAIDs-PDL |
| Feb 17, 2009 |
Ophthalmic Prostaglandin Agonists PDL |
| Apr 29, 2009 |
Oral
AntiDiabetics: Combinations-PDL |
| Feb 17, 2009 |
Otic
Quinolones-PDL |
| Jan 31, 2005 |
Oxandrin® |
| Jul 15, 2009 |
Platelet Inhibitor-PDL |
| Sep 26, 2005 |
Prostin
VR® Pediatric |
| Jul 21, 2008 |
Proton
Pump Inhibitor-PDL |
| Feb 17, 2009 |
Pulmonary Hypertension Agents-PDL |
| Feb 17, 2009 |
Quinolone
Ophthalmic Antibiotic-PDL |
| Jun 13, 2007 |
Ranexa® |
| Jan 12, 2005 |
Raniclor™ |
| Dec 23, 2004 |
Raptiva |
| Jun 22, 2005 |
Retinoic
Acid Products/Retinoid Analogues - Topical |
| Jul 21, 2008 |
Ribavirins
- PDL |
| Aug 12, 2009 |
Sedative
Hypnotics-PDL |
| Apr 29, 2009 |
Selective
Serotonin Reuptake Inhibitor (SSRI) |
| Jul 15, 2009 |
Skeletal Muscle |
| Aug 21, 2003 |
Suboxone |
| Jul 29, 2003 |
Sucralfate
(Carafate) |
| Feb 17, 2009 |
Sulfonylureas-PDL |
| Sep 28, 2006 |
Synagis
(palivizumab) |
| May 12, 2006 |
Tamiflu® |
| Jul 07, 2003 |
Thalomid
(thalidomide) |
| Apr 29, 2009 |
Thiazolidinediones
- PDL |
| Oct 29, 2007 |
Tindamax® |
| Feb 17, 2009 |
Topical
Agents for Psoriasis - PDL |
| Feb 17, 2009 |
Topical Androgenic Agents |
| Jul 15, 2009 |
Topical Benzoyl Peroxide/Clindamycin Combination |
| Jul 21, 2008 |
Topical
Immunomodulators - PDL |
| Apr 22, 2009 |
Topical Retinoids - PDL |
| Apr 14, 2006 |
Tramadol
Therapy |
| Jan 16, 2004 |
Tricyclic
Antidepressant Coordination of Care |
| Jul 15, 2009 |
TriGlyceride
Lower Agents-PDL |
| Jul 06, 2009 |
Ulcerative Colitis Oral Agents-PDL |
| Sep 17, 2009 |
Ulcerative Colitis-Rectal-PDL |
| Jul 15, 2009 |
Urinary
Tract Antispasmodics - PDL |
| Apr 15, 2009 |
Vivitrol ® |
| Mar 07, 2003 |
Voriconazole
(Vfend) / Antifungal |
| Nov 13, 2003 |
Xanax
XR® (Alprazolam) |
| Mar 25, 2005 |
Xolair |
| Nov 13, 2003 |
Zometa® (zoledronic
acid) |
| Apr 11, 2007 |
Zostavax
Injection |
| Jan 13, 2005 |
Zyprexa
IM® |
