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
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
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, Mupirocin Topical PDL Edit
Antibiotics, Vaginal PDL Edit
Anticholinergics, Long Acting Beta Adrenergic (LABA) Combinations PDL Edit
Anticholinergics, Long Acting Beta Adrenergics (LABA)/ Inhaled Corticosteroid (ICS) Combinations PDL Edit
Anticholinergics, Long Acting Inhaled PDL Edit
Anticholinergics, Short Acting and Combinations Inhaled PDL Edit
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