Drug Prior Authorization Committee Meeting Materials

Meeting information is retained on this page for 7 years then sent to the Missouri State Archives.

Register for Public Comment

Any interested party shall be granted the opportunity for clinically relevant public comment for up to three (3) minutes per medication under review by the PAC. The responsibility of scheduling the presentation shall rest with the interested party, and registration must be completed prior to the scheduled meeting. Interested parties representing a manufacturer shall be granted three (3) minutes in the aggregate per medication under review by the PAC.

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2025

April 15, 2025

DPAC Agenda April 2025
DPAC Minutes January 2025 Draft
DUR Criteria
Clinical and Fiscal Edits- Existing Criteria
Media
Acne and Rosacea – Select Topical Agents Step Therapy Edit April 2025
Antifungals, Systemic Clinical Edit April 2025
Cough and Cold Preparations Fiscal Edit April 2025
Fabry Disease Clinical Edit April 2025
Givlaari Clinical Edit April 2025
Isturisa Clinical Edit April 2025
Megestrol Acetate Clinical Edit April 2025
Nulibry Clinical Edit April 2025
Oxervate Clinical Edit April 2025
Pompe Disease Clinical Edit April 2025
Voxzogo Clinical Edit April 2025
DUR Criteria
Clinical and Fiscal Edits- New or Revised of Existing Criteria
Media
Imcivree Clinical Edit April 2025
Kebilidi Clinical Edit April 2025
Prior Authorization Required Fiscal Edit April 2025
Zokinvy Clinical Edit April 2025
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Actinic Keratosis Agents, Topical PDL Edit April 2025
Antibiotics, Inhaled PDL Edit April 2025
Anticholinergics, Long Acting Beta Adrenergic (LABA) Combinations PDL Edit April 2025
Anticholinergics, Long Acting Inhaled PDL Edit April 2025
Anticholinergics, Short Acting and Combinations Inhaled PDL Edit April 2025
Antifungals (Onychomycosis/Candidiasis), Oral PDL Edit April 2025
Antihistamines, Intranasal PDL Edit April 2025
Antihistamines, Ophthalmic PDL Edit April 2025
Antivirals, Herpes Oral PDL Edit April 2025
Antivirals, Topical PDL Edit April 2025
Benzoyl Peroxide/Antibiotic Combinations PDL Edit April 2025
Beta Adrenergic Agents, Long Acting PDL Edit April 2025
Beta Adrenergic Agents, Nebulized PDL Edit April 2025
Corticosteroids & Rhinitis Agents, Intranasal PDL Edit April 2025
Corticosteroids, Ophthalmic “Soft” PDL Edit April 2025
Corticosteroids, Oral Inhaled PDL Edit April 2025
Fluoroquinolones, Ophthalmic PDL Edit April 2025
Fluoroquinolones, Otic PDL Edit April 2025
Hepatitis C Agents PDL Edit April 2025
Inflammatory Bowel Disease Agents, Rectal PDL Edit April 2025
Leukotriene Receptor Modifiers PDL Edit April 2025
Mast Cell Stabilizers, Ophthalmic PDL Edit April 2025
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Ophthalmic PDL Edit April 2025
Pancreatic Enzyme Agents PDL Edit April 2025
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Androgenic Agents PDL Edit April 2025
Anticholinergics, Long Acting Beta Adrenergics (LABA)/ Inhaled Corticosteroid (ICS) Combinations PDL Edit April 2025
Antifungals, Topical PDL Edit April 2025
Antihistamines and Antihistamine/Decongestant Combinations, 2nd Generation PDL Edit April 2025
Anti-Migraine, Alternative Agents PDL Edit April 2025
Antiparasitics, Topical PDL Edit April 2025
Beta Adrenergic Agents, Short Acting PDL Edit April 2025
Corticosteroids, Topical PDL Edit April 2025
Epinephrine Self-Administered Agents PDL Edit (Formerly Epinephrine Self-Injectable Agents) April 2025
Glaucoma Agents PDL Edit April 2025
Inflammatory Bowel Disease Agents, Oral PDL Edit April 2025
Phosphodiesterase (PDE) Inhibitors for Chronic Obstructive Pulmonary Disease (COPD) PDL Edit April 2025
Retinoids, Topical PDL Edit April 2025

January 14, 2025

DPAC Agenda January 2025
DPAC Minutes January 2025 Draft
DUR Criteria
Clinical and Fiscal Edits- Existing Criteria
Media
Antipsychotics - 1st Generation (Typical) January 2025
Benzodiazepine (Select Oral) January 2025
Butalbital Combinations without Codeine January 2025
Camzyos January 2025
Corlanor January 2025
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators January 2025
HBV Nucleotide Analog Reverse Transcriptase Inhibitors January 2025
High Risk Therapies January 2025
Morphine Milligram Equivalent Accumulation January 2025
Selzentry January 2025
Sohonos January 2025
Verquvo January 2025
Ztalmy January 2025
DUR Criteria
Clinical and Fiscal Edits- New or Revised of Existing Criteria
Media
Anti-Amyloid Monoclonal Antibody January 2025
Botulinum Toxin January 2025
Duchenne Muscular Dystrophy January 2025
Enzyme Deficiency Select Agents January 2025
Hypoxia-Inducible Factor Prolyl Hydroxylase (HIF-PH) Stabilizers January 2025
Lenmeldy January 2025
Opioids, Short-Acting January 2025
Prior Authorization Required Fiscal Edit January 2025
Skysona January 2025
DUR Criteria
Resource List - New or Revised Criteria
Media
Antipsychotics - 2nd Generation (Atypical) Depot Agents Resource List January 2025
Antipsychotics - 2nd Generation (Atypical) Oral & Transdermal Agents Resource List January 2025
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Alzheimer’s Agents, Acetylcholinesterase Inhibitors, N-Methyl-D-Aspartate Receptor Antagonists & Combinations January 2025
Antibiotics, Gastrointestinal (GI) January 2025
Antibiotics, Mupirocin Topical January 2025
Anti-Migraine, Serotonin (5-HT1) Receptor Agonists January 2025
Anti-Parkinsonism, MAO-B Inhibitors January 2025
Anti-Parkinsonism, Non-Ergot Dopamine Agonists January 2025
Fibromyalgia Agents January 2025
Glucagon Agents January 2025
Hereditary Angioedema Agents January 2025
Opioids, Long Acting January 2025
Sedative Hypnotics January 2025
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Antibiotics, Vaginal January 2025
Anticonvulsants, Dravet Syndrome January 2025
Antiemetics, 5-HT3 and NK1 Injectables January 2025
Antiemetics, 5-HT3, NK1 and Other Select Non-Injectables January 2025
Anti-Migraine, Alternative Agents January 2025
Antiretroviral Therapy (ART) January 2025
Calcitonin Gene-Related Peptide (CGRP) Inhibitors January 2025
Cephalosporin Agents January 2025
Fluoroquinolones, Oral January 2025
Gene Therapies for Sickle Cell Disease and Beta-Thalassemia January 2025
GI Motility Agents, Chronic January 2025
Macrolides January 2025
Neuropathic Pain Agents January 2025
NSAIDs January 2025
Opioid & Select Alcohol Dependence Agents January 2025
Opioid Emergency Reversal Agents January 2025
Penicillin Agents January 2025
Skeletal Muscle Relaxants January 2025
Somatostatin Analogs January 2025
Tetracyclines January 2025
Tramadol-Like Agents January 2025
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors January 2025

2024

October 15, 2024

DPAC Agenda October 2024
DPAC Minutes October 2024 Approved
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
ACE Inhibitors Diuretic Combinations PDL Edit October 2024
ACE Inhibitors and Calcium Channel Blocker Combinations PDL Edit October 2024
ADHD, Amphetamines Short Acting PDL Edit October 2024
ADHD, Methylphenidate Short Acting PDL Edit October 2024
Antiandrogenic Agents PDL Edit October 2024
Antihyperuricemic Agents PDL Edit October 2024
Antiplatelet Agents PDL Edit October 2024
ARB and ARB/Diuretic Combinations PDL Edit October 2024
ARB and Calcium Channel Blocker Combinations PDL Edit October 2024
Benign Prostatic Hyperplasia Agents PDL Edit October 2024
Calcium Channel Blockers, Non-Dihydropyridine PDL Edit October 2024
Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors PDL Edit October 2024
Direct Renin Inhibitors & Combinations PDL Edit October 2024
Homozygous Familial Hypercholesterolemia (HoFH) Agents PDL Edit October 2024
Mitogen-activated Extracellular Kinase Inhibitors (MEKi) & B-raf Kinase Inhibitors (BRAFi) PDL Edit October 2024
Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Inhaled PDL Edit October 2024
Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Injectable PDL Edit October 2024
Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Oral PDL Edit October 2024
Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) Inhibitors PDL Edit October 2024
Triglyceride Lowering Agents PDL Edit October 2024
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
GLP-1 Receptor Agonists & Combination Agents Indicated for Diabetes PDL Edit October 2024
GLP-1 Receptor Agonists Indicated for Obesity PDL Edit October 15, 2024
ADHD, Amphetamines Long Acting PDL Edit October 2024
ADHD, Methylphenidate Long Acting PDL Edit October 2024
ADHD, Non-Stimulants PDL Edit October 2024
Anticoagulants, Oral and Subcutaneous PDL Edit October 2024
Anticonvulsants, Rescue Agents PDL Edit October 2024
Beta Adrenergic Blockers & Beta Adrenergic Blockers/Diuretic Combinations PDL Edit October 2024
Bile Salt Agents PDL Edit October 2024
Bone Ossification Agents PDL Edit October 2024
Calcium Channel Blockers, Dihydropyridine PDL Edit October 2024
Electrolyte Depleting Agents, Phosphate Lowering PDL Edit October 2024
Electrolyte Depleting Agents, Potassium Lowering PDL Edit October 2024
Keratoconjunctivitis Agents PDL Edit October 2024
Lipotropics, Alternative Agents PDL Edit October 2024
Mineralocorticoid Receptor Antagonists (MRA) PDL Edit October 2024
Pulmonary Arterial Hypertension (PAH) Agents, Endothelin Receptor Antagonists (ETRAs) PDL Edit October 2024
Pulmonary Arterial Hypertension (PAH) Agents, Phosphodiesterase-5 (PDE5) and Soluble Guanylate Cyclase (SGC) Stimulators PDL Edit October 2024
Proton Pump Inhibitors (PPIs) PDL Edit October 2024
Statins (HMG-CoA Reductase Inhibitors) and Combinations PDL Edit October 2024
Sympatholytics PDL Edit October 2024
Systemic Enzyme Inhibitors, FGFR Inhibitors PDL Edit October 2024
Transthyretin Amyloidosis Agents PDL Edit October 2024
Urea Cycle Disorder Agents PDL Edit October 2024
DUR Criteria
Clinical and Fiscal Edits- Existing Criteria
Media
Emsam Clinical Edit October 2024
Entresto Clinical Edit October 2024
Immunoglobulins (IVIG and SCIG) Clinical Edit October 2024
Lambert-Eaton Myasthenic Syndrome (LEMS) Clinical Edit October 2024
Nuedexta Clinical Edit October 2024
Ranolazine Clinical Edit October 2024
Skyclarys Clinical Edit October 2024
SNRI Clinical Edit October 2024
Spinal Muscular Atrophy (SMA) Clinical Edit October 2024
SSRI Step Therapy Clinical Edit October 2024
Xcopri Clinical Edit October 2024
DUR Criteria
Clinical and Fiscal Edits- New or Revised of Existing Criteria
Media
Allergenics, Oral Clinical Edit October 2024
Alpelisib Clinical Edit October 2024
Auvelity Clinical Edit October 2024
Diagnosis Code Required Policy Edit October 2024
Duchenne Muscular Dystrophy Clinical Edit October 2024
Enzyme Deficiency, Select Agents Clinical Edit October 2024
Epidermolysis Bullosa Clinical Edit October 2024
Hemophilia Gene Therapy Agents Clinical Edit October 2024
Metabolic Dysfunction-Associated Steatohepatitis (MASH) Clinical Edit October 2024
Narcolepsy Inhibitors Clinical Edit October 2024
Parathyroid Hormone and Bone Resorption Suppression Related Agents Clinical Edit October 2024
Prior Authorization Required Fiscal Edit October 15, 2024
Psychotropic Medications Polypharmacy Clinical Edit October 2024
Sickle Cell Disease Clinical Edit October 2024
Winrevair Clinical Edit October 2024
Xolremdi Clinical Edit October 2024

July 16, 2024

DPAC Agenda July 2024
DPAC Minutes July 2024 Approved
DUR Criteria
Clinical and Fiscal Edits- Existing Criteria
Media
Ampyra July 2024
Crysvita July 2024
Daybue July 2024
Filspari July 2024
Gamifant July 2024
Iron Injectable July 2024
Joenja July 2024
Koselugo July 2024
Luxturna July 2024
NMOSD July 2024
RSV Prophylaxis Pediatric July 2024
Tzield July 2024
Zometa July 2024
DUR Criteria
Clinical and Fiscal Edits- New or Revised of Existing Criteria
Media
Besremi July 2024
CAR-T Cell July 2024
Duchenne Muscular Dystrophy July 2024
GABAA Modulators for PPD July 2024
Primary Hyperoxaluria July 2024
Prior Authorization Required Fiscal Edit July 2024
Reblozyl July 2024
Targeted Immune Modulators Small Molecule JAK July 2024
Tepezza July 2024
Tolvaptan July 2024
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Alpha Glucosidase Inhibitors July 2024
Amylin Analogs July 2024
Biguanides & Combination Agents July 2024
Erythropoiesis Stimulating Agents July 2024
Insulin, Non-Analogs July 2024
LHRH GnRH Agents, Oral July 2024
Meglitinides July 2024
Methotrexate Agents July 2024
Multiple Sclerosis Agents July 2024
Sulfonylurea Agents, Second Generation July 2024
Thiazolidinediones & Combination July 2024
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Atopic Dermatitis Agents, Immunomodulators July 2024
Bleeding Disorder Agents July 2024
Colony Stimulating Factors July 2024
Complement Inhibitors Systemic July 2024
Cryopyrin Associated Periodic Syndrome Agents July 2024
DPP-IV Inhibitors July 2024
Growth Hormone Agents, Somatropin July 2024
Growth Hormone Releasing Factors, Select Agents July 2024
Insulin, Long Acting July 2024
Insulin, Mixed July 2024
Insulin, Rapid Acting July 2024
LHRH GnRH Agents, Non-Oral July 2024
Multiple Sclerosis Agents, Injectable July 2024
Neonatal Fc Receptor Antagonists July 2024
Psoriasis Agents, Oral July 2024
Psoriasis Agents, Topical July 2024
SGLT Inhibitors July 2024
Targeted Immune Modulators JAK Inhibitors July 2024
Targeted Immune Modulators IL-6 Inhibitors July 2024
Targeted Immune Modulators IL-17 Receptor Antagonist July 2024
Targeted Immune Modulators IL-23 Inhibitors and IL-23/IL-12 Inhibitors July 2024
Targeted Immune Modulators Lupus Agents July 2024
Targeted Immune Modulators Misc. Allergy and Asthma RMA July 2024
Targeted Immune Modulators Select Agents July 2024
Targeted Immune Modulators TNF Inhibitors July 2024
Thrombocytopenia Agents July 2024
Urinary Tract Antispasmodics July 2024

April 16, 2024

DPAC Agenda April 2024
DPAC Minutes April 2024 Approved
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Givlaari April 2024
Imcivree April 2024
Megestrol Acetate April 2024
Nulibry April 2024
Scenesse April 2024
Spravato April 2024
Zokinvy April 2024
DUR Criteria
Clinical and Fiscal Edits- New or Revised of Existing Criteria
Media
Acne or Rosacea Select Topical April 2024
Antifungals Systemic April 2024
Fabry Disease April 2024
GABAA Modulators for PPD April 2024
Isturisa April 2024
Oxervate April 2024
Pompe Disease April 2024
Prior Auth Required Fiscal Edit April 2024
Voxzogo April 2024
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Actinic Keratosis Agents, Topical April 2024
Androgenic Agents April 2024
Antibiotics, Inhaled April 2024
Anticholinergics, Long Acting Beta Adrenergic (LABA) Combinations April 2024
Anticholinergics, Short Acting and Combinations Inhaled April 2024
Antifungals (Onychomycosis/Candidiasis), Oral April 2024
Antifungals, Topical April 2024
Antihistamines and Antihistamine/Decongestant Combinations, 2nd Generation April 2024
Antihistamines, Intranasal April 2024
Antihistamines, Ophthalmic April 2024
Antiparasitics, Topical April 2024
Antivirals, Herpes Oral April 2024
Antivirals, Topical April 2024
Beta Adrenergic, Long Acting April 2024
Beta Adrenergic, Nebulized April 2024
Corticosteroids, Ophthalmic “Soft” April 2024
Corticosteroids, Topical April 2024
Fluoroquinolones, Ophthalmic April 2024
Leukotriene Receptor Modifiers April 2024
Mast Cell Stabilizers, Ophthalmic April 2024
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Ophthalmic April 2024
Pancreatic Enzyme Agents April 2024
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Anticholinergics, Long Acting Beta Adrenergics (LABA)/ Inhaled Corticosteroid (ICS) Combinations and Phosphodiesterase 4 (PDE4) Inhibitors April 2024
Anticholinergics, Long Acting Inhaled April 2024
Benzoyl Peroxide/Antibiotic Combinations April 2024
Beta Adrenergic Agents, Short Acting April 2024
Corticosteroids & Rhinitis Agents, Intranasal April 2024
Corticosteroids, Oral Inhaled April 2024
Cough and Cold Preparations April 2024
Epinephrine Agents, Self-Injectable April 2024
Fluoroquinolones, Otic April 2024
Gene Therapies for Sickle Cell Disease and Beta-Thalassemia April 2024
Glaucoma Agents April 2024
Hepatitis C Agents April 2024
Inflammatory Bowel Disease Agents, Oral April 2024
Inflammatory Bowel Disease Agents, Rectal April 2024
Retinoids, Topical April 2024

January 16, 2024

DPAC Agenda January 2024
DPAC Minutes January 2024 Approved
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Benzodiazepines Select Oral January 2024
Butalbital Combo January 2024
Camzyos January 2024
Corlanor January 2024
Empaveli January 2024
Enjaymo January 2024
HBV Nucleotide Analog Reverse Transcriptase Inhibitors January 2024
High Risk Therapies January 2024
Morphine Milligram Equivalent Accumulation January 2024
Non-Oral Contraceptives January 2024
Selzentry January 2024
Skysona January 2024
Tavneos January 2024
Transmucosal Immediate Release Fentanyl (TIRF) January 2024
Verquvo January 2024
Zynteglo January 2024
DUR Criteria
Clinical Edit Proposals – New or Revised Criteria
Media
Anti-Amyloid Monoclonal Antibody January 2024
Antipsychotics - 1st Generation (Typical) January 2024
Auvelity January 2024
C5 Complement Inhibitors January 2024
Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) Modulators January 2024
Duchenne Muscular Dystrophy (DMD) January 2024
Hemophilia Gene Therapy Agents January 2024
Hypoxia-Inducible Factor Prolyl Hydroxylase (HIF-PH) Stabilizers January 2024
Opioids – Short-Acting January 2024
Sohonos January 2024
Ztalmy January 2024
DUR Criteria
Resource List - New or Revised Criteria
Media
Antipsychotics - 2nd Generation (Atypical) Depot Agents January 2024
Antipsychotics - 2nd Generation (Atypical) Oral & Transdermal Agents January 2024
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Alzheimer’s Agents, Acetylcholinesterase Inhibitors, N-Methyl-D-Aspartate Receptor Antagonists & Combinations January 2024
Antibiotics, Mupirocin Topical January 2024
Anti-Migraine, Serotonin (5-HT1) Receptor Agonists January 2024
Anti-Parkinsonism, MAO-B Inhibitors January 2024
Anti-Parkinsonism, Non-Ergot Dopamine Agonists January 2024
Calcitonin Gene-Related Peptide (CGRP) Inhibitors January 2024
Cephalosporin Agents January 2024
Cyclin-Dependent Kinase (CDK) 4/6 Inhibitors January 2024
Fluoroquinolones, Oral January 2024
Hereditary Angioedema Agents January 2024
Macrolides January 2024
NSAIDs January 2024
Opioids, Long Acting January 2024
Penicillin Agents January 2024
Somatostatin Analogs January 2024
Tetracyclines January 2024
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Antiandrogenic Agents January 2024
Antibiotics, Gastrointestinal (GI) January 2024
Antibiotics, Vaginal January 2024
Anticonvulsants, Dravet Syndrome January 2024
Antiemetics, 5-HT3 and NK1 Injectables January 2024
Antiemetics, 5-HT3, NK1 and Other Select Non-Injectables January 2024
Anti-Migraine, Alternative Agents January 2024
Antiretroviral Therapy (ART) January 2024
Fibromyalgia Agents January 2024
GI Motility Agents, Chronic January 2024
Glucagon Agents January 2024
Mitogen-activated Extracellular Kinase Inhibitors (MEKi) & B-raf Kinase Inhibitors (BRAFi) January 2024
Neuropathic Pain Agents January 2024
Opioid & Select Alcohol Dependence Agents January 2024
Opioid Emergency Reversal Agents January 2024
Sedative Hypnotics January 2024
Skeletal Muscle Relaxants January 2024
Systemic Enzyme Inhibitors, FGFR Inhibitors January 2024
Tramadol-Like Agents January 2024
Vesicular Monoamine Transporter 2 (VMAT2) Inhibitors January 2024

2023

October 17, 2023

DPAC Agenda October 2023
DPAC Minutes October 2023 Approved
DUR Criteria
Old Business
Media
Neuromyelitis Optica Spectrum Disorder October 2023
C5 Complement Inhibitors October 2023
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Alpelisib October 2023
Emsam October 2023
Entresto October 2023
Immunoglobulins IVIG and SCIG October 2023
Narcolepsy Inhibitors October 2023
Nuedexta October 2023
Palforzia October 2023
Parathyroid Hormone and Bone Resorption Suppression Related Agents October 2023
Sickle Cell Disease October 2023
Spinal Muscular Atrophy October 2023
SSRI Step Therapy October 2023
Transthyretin Mediated Amyloidosis ATTR October 2023
Xcopri October 2023
DUR Criteria
Clinical Edit Proposals – New or Revised Criteria
Media
Botulinum Toxin October 2023
Diagnosis Code Required Policy October 2023
Enzyme Deficiency Select Agents October 2023
Generalized Myasthenia Gravis October 2023
Lambert Eaton Myasthenic Syndrome October 2023
Psychotropic Medications Polypharmacy October 2023
Ranolazine October 2023
RSV Prophylaxis Pediatric October 2023
Skyclarys October 2023
SNRI October 2023
Vyjuvek October 2023
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
ACE Inhibitors CCB Combinations October 2023
ADHD Amphetamines Short Acting October 2023
ADHD Methylphenidate Short Acting October 2023
ADHD Non Stimulants October 2023
ARB CCB Combo October 2023
Anticonvulsants Rescue Agents October 2023
Antiplatelet Agents October 2023
BAB And Diuretic Combos October 2023
Bone Ossification Agents October 2023
CCBs Dihydropyridine October 2023
Direct Renin Inhibitors and Combos October 2023
Electrolyte Depleting Agents Phosphate Lowering October 2023
Niacin Derivatives October 2023
PCSK9 Inhibitors October 2023
PAH Agents ETRAs October 2023
PAH Agents PPAs Inhaled October 2023
PAH Agents PPAs Injectable October 2023
PAH Agents PPAs Oral October 2023
Triglyceride Lowering Agents October 2023
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
ACE Inhibitors Diuretic Combos October 2023
ADHD Amphetamines Long Acting October 2023
ADHD Methylphenidate Long Acting October 2023
ARBs and ARB Diuretic Combos October 2023
Anticoagulants Oral and Subcutaneous October 2023
Antihyperuricemic Agents October 2023
Benign Prostatic Hyperplasia Agents October 2023
Beta Adrenergic Agents Short Acting October 2023
Bile Salt Agents October 2023
CCBs Non Dihydropyridine October 2023
Electrolyte Depleting Agents Potassium Lowering October 2023
HoFH Agents October 2023
Keratoconjunctivitis Agents October 2023
Mineralocorticoid Receptor Antagonists October 2023
Proton Pump Inhibitors October 2023
PAH Agents PDE5 and SGC Stimulators October 2023
Statins HMG CoA Reductase Inhibitors and Combos October 2023
Sympatholytics October 2023
Urea Cycle Disorder Agents October 2023

July 18, 2023

Agenda July 2023
DPAC Minutes July 2023 Approved
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Ampyra July 2023
Besremi July 2023
C5 Complement Inhibitors July 2023
CAR T Cell July 2023
Crysvita July 2023
DMD July 2023
Gamifant July 2023
Iron Injectable July 2023
Koselugo July 2023
Luxturna July 2023
NMOSD July 2023
Reblozyl July 2023
TIMS Small Molecule JAK Inhibitor July 2023
Tolvaptan July 2023
Vyvgart July 2023
Zometa July 2023
DUR Criteria
Clinical Edit Proposals – New or Revised Criteria
Media
Daybue July 2023
Enjaymo July 2023
Filspari July 2023
Givlaari July 2023
Joenja July 2023
Synagis July 2023
Tepezza July 2023
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Alpha Glucosidase Inhibitors July 2023
Amylin Analogs July 2023
Biguanides and Combination Agents July 2023
Cryopyrin Associated Periodic Syndrome July 2023
DPPIV July 2023
Erythropoiesis Stimulating Agents July 2023
GLP1s and Combination Agents July 2023
Insulin Mixed July 2023
Insulin Non Analogs July 2023
Insulin Rapid Acting July 2023
LHRH GnRH Agents Oral July 2023
Meglitinides July 2023
Methotrexate Agents July 2023
Psoriasis Agents Oral July 2023
Sulfonylurea Agents 2nd Generation July 2023
Thiazolidinediones and Combos July 2023
TIMs IL17 Receptor Antagonists July 2023
TIMs IL23 12 Inhibitors July 2023
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Atopic Dermatitis Agents Immunomodulators July 2023
Bleeding Disorder Agents July 2023
Colony Stimulating Factors July 2023
Growth Hormone Agents Somatropin July 2023
Growth Hormone Releasing Factors Select Agents July 2023
Insulin Long Acting July 2023
LHRH GnRH Agents Non Oral July 2023
Multiple Sclerosis Agents Injectable July 2023
Multiple Sclerosis Agents Oral July 2023
Psoriasis Agents Topical July 2023
SGLT Inhibitors July 2023
Thrombocytopenia Agents July 2023
TIMs IL6 Receptor Inhibitors July 2023
TIMs JAK Inhibitors July 2023
TIMs Allergy and Asthma Related Monoclonal Antibodies July 2023
TIMs Select Agents July 2023
TIMs TNF Inhibitors July 2023
Urinary Tract Antispasmodics July 2023

April 18, 2023

Agenda April 2023
Minutes April 2023
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Acne and Rosacea Select Topical Agents April 2023
Fabry Disease April 2023
Givlaari April 2023
Imcivree April 2023
Isturisa April 2023
Megestrol Acetate April 2023
Nulibry April 2023
Oxervate April 2023
Oxlumo April 2023
Scenesse April 2023
Sickle Cell Disease April 2023
Spravato April 2023
Systemic Antifungals April 2023
Tavneos April 2023
Voxzogo April 2023
Zokinvy April 2023
Zulresso April 2023
DUR Criteria
Clinical Edit Proposals – New or Revised Criteria
Media
Hemgenix April 2023
Tzield April 2023
DUR Criteria
Preferred Drug List Edit Proposals – Existing Criteria
Media
Actinic Keratosis Agents Topical April 2023
Androgenic Agents April 2023
Antibiotics Inhaled April 2023
Anticholinergics LABA Combinations April 2023
Anticholinergics Short Acting and Combos Inhaled April 2023
Antifungals Topical April 2023
Antihistamines Decongestant Combos 2G April 2023
Antihistamines Intranasal April 2023
Antiparasitics Topical April 2023
Antivirals Herpes Oral April 2023
Benzoyl Peroxide Antibiotic Combinations April 2023
Beta Adrenergic Agents Nebulized April 2023
Beta Adrenergic Agents Short Acting April 2023
Corticosteroids Ophthalmic Soft April 2023
Corticosteroids Topical April 2023
Cough and Cold Preparations April 2023
Fluoroquinolones Ophthalmic April 2023
Fluoroquinolones Otic April 2023
Hepatitis C Agents April 2023
Leukotriene Receptor Modifiers April 2023
Mast Cell Stabilizers Ophthalmic April 2023
NSAIDS Ophthalmic April 2023
Pancreatic Enzyme Agents April 2023
Retinoids Topical April 2023
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Anticholinergics LABAs ICS Combos PDE4 Inhibitors April 2023
Anticholinergics Long Acting Inhaled April 2023
Antifungals Oral April 2023
Antihistamines Ophthalmic April 2023
Antivirals Topical April 2023
Beta Adrenergic Agents Long Acting April 2023
Corticosteroids and Rhinitis Agents Intranasal April 2023
Epinephrine Agents Self Injectable April 2023
Glaucoma Agents April 2023
Inflammatory Bowel Disease Agents Oral April 2023
Inflammatory Bowel Disease Agents Rectal April 2023

2022

December 15, 2022

Agenda December 2022
Minutes December 2022
DUR Criteria
Clinical Edit Proposals – Existing Criteria
Media
Aduhelm December 2022
Antipsychotics 1st Generation Typical December 2022
Benzodiazepine Select Oral December 2022
Butalbital Combos without Codeine December 2022
Corlanor December 2022
Empaveli December 2022
HBV Nucleotide Analog Reverse Transcriptase Inhibitors December 2022
High Risk Therapies December 2022
Kerendia December 2022
Morphine Milligram Equivalent MME Accumulation December 2022
Non-Oral Contraceptives December 2022
Oxazolidinone December 2022
Pompe Disease December 2022
Selzentry December 2022
Transmucosal Immediate Release Fentanyl TIRF December 2022
Verquvo December 2022
DUR Criteria
Clinical Edit Proposals – New or Revised Criteria
Media
Camzyos December 2022
Cystic Fibrosis Transmembrane Conductance Regulator Modulators December 2022
Opioids Short Acting December 2022
Skysona December 2022
Xenpozyme December 2022
Ztalmy December 2022
Zynteglo December 2022
DUR Criteria
Resource List - New or Revised Criteria
Media
Antipsychotics 2nd Generation Atypical Depot Agents December 2022
Antipsychotics 2nd Generation Atypical Oral and Transdermal Agents December 2022
DUR Criteria
Preferred Drug List Review - Existing Criteria
Media
Alzheimer’s Agents AChEIs and NMDA Receptor Antagonists and Combos December 2022
Antiemetics 5HT3 and NK1 Injectables December 2022
Antiemetics 5HT3 NK1 and Other Select Non-Injectables December 2022
Anti Migraine Serotonin 5HT1 Receptor Agonists December 2022
Anti Parkinsonism MAO B Inhibitors December 2022
Anti Parkinsonism Non Ergot Dopamine Agonists December 2022
Cyclin Dependent Kinase Inhibitors December 2022
Glucagon Agents December 2022
Hereditary Angioedema Agents December 2022
NSAIDs December 2022
Opioid Emergency Reversal Agents December 2022
Opioids Long Acting December 2022
Somatostatin Analogs December 2022
Vesicular Monoamine Transporter 2 Inhibitors December 2022
DUR Criteria
Preferred Drug List Edit Proposals – New or Revised Criteria
Media
Antiandrogenic Agents December 2022
Anticonvulsants Dravet Syndrome December 2022
Anti Migraine Alternative Oral Agents December 2022
Antiplatelet Agents December 2022
Antiretroviral Therapy December 2022
Calcitonin Gene Related Peptide Inhibitors December 2022
Fibromyalgia Agents December 2022
GI Motility Agents Chronic December 2022
MEKi and BRAFi December 2022
Neuropathic Pain Agents December 2022
Opioid and Select Alcohol Dependence Agents December 2022
Sedative Hypnotics December 2022
Skeletal Muscle Relaxants December 2022
Tramadol Like Agents December 2022