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
Antifungals, Systemic Clinical Edit
Antifungals, Topical PDL Edit
Antihistamines and Antihistamine/Decongestant Combinations, 2nd Generation PDL Edit
Antihistamines, Intranasal PDL Edit
Antihistamines, Ophthalmic PDL Edit
Antihyperuricemic Agents PDL Edit
Antiparasitics, Topical PDL Edit
Antiplatelet Agents PDL Edit
Antipsychotics - 1st Generation (Typical) Clinical Edit || Antipsychotic Prior Authorization - Children Less Than 9 Years Old
Antipsychotics - 2nd Generation (Atypical) Depot Agents Resource List || Antipsychotic Prior Authorization - Children Less Than 9 Years Old
Antipsychotics - 2nd Generation (Atypical) Oral & Transdermal Agents Resource List || Antipsychotic Prior Authorization - Children Less Than 9 Years Old
Antiretroviral Therapy (ART) PDL Edit
Antivirals, Herpes Oral PDL Edit
Antivirals, Topical PDL Edit
Atopic Dermatitis Agents, Immunomodulators PDL Edit
Auvelity Clinical Edit
Benign Prostatic Hyperplasia Agents PDL Edit
Benzodiazepines select-oral Clinical Edit || Benzodiazepine Prior Authorization
Benzoyl Peroxide/Antibiotic Combinations PDL Edit
Besremi Clinical Edit
Beta Adrenergic Agents, Long Acting PDL Edit
Beta Adrenergic Agents, Nebulized PDL Edit
Beta Adrenergic Agents, Short Acting PDL Edit
Beta Adrenergic Blockers & Beta Adrenergic Blockers/Diuretic Combinations PDL Edit
Biguanides & Combination Agents PDL Edit
Bile Salt Agents PDL Edit
Biosimilar vs Reference Products Fiscal Edit 4-9-26
Bleeding Disorder Agents PDL Edit
Bone Ossification Agents PDL Edit
Botulinum Toxin Clinical Edit
Brand-Over-Generic Fiscal Edit
Butalbital Combinations Without Codeine Clinical Edit
Calcitonin Gene-Related Peptide (CGRP) Inhibitors PDL Edit
Calcium Channel Blockers, (Dihydropyridines) PDL Edit
Calcium Channel Blockers, Non-Dihydropyridine PDL Edit
Camzyos Clinical Edit
Cephalosporin Agents PDL Edit
Colony Stimulating Factors PDL Edit
Complement Inhibitors, Systemic PDL Edit
Continuous Glucose Monitors (CGMs) Clinical Edit || Continuous Glucose Monitoring Device and/or Tubeless Insulin Pump Prior Authorization