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
Luxturna Clinical Edit
Macrolides PDL Edit
Manufacturers-Requiring PA Fiscal Edit
Mast Cell Stabilizers, Ophthalmic PDL Edit
Megestrol Acetate Clinical Edit
Meglitinide Agents PDL Edit
Metabolic Dysfunction-Associated Steatohepatitis Clinical Edit
Methotrexate Agents PDL Edit
Mineralocorticoid Receptor Antagonists (MRA) PDL Edit
Mitogen-activated Extracellular Kinase Inhibitors (MEKi) & B-raf Kinase Inhibitors (BRAFi) PDL Edit
Morphine Milligram Equivalent Accumulation Clinical Edit
Multiple Sclerosis Agents, Injectable PDL
Multiple Sclerosis, Oral Agents PDL
Myelodysplastic Syndromes Agents (Formerly Reblozyl) Clinical Edit
Narcolepsy Clinical Edit 04-16-26
Neonatal Fc Receptor Antagonists PDL Edit
Neurofibromatosis Type 1 (formerly Koselugo) Clinical Edit
Neuromyelitis Optica Spectrum Disorder (NMOSD) Clinical Edit
Neuropathic Pain Agents PDL Edit || Gabapentin
Non Oral Contraceptives Fiscal Edit
NSAIDs PDL Edit
NSAIDs, Ophthalmic PDL Edit
Nuedexta Clinical Edit
Nulibry Clinical Edit
Opioid and Select Alcohol Dependence Agents PDL Edit
Opioid Reversal Agents
Opioids, Long Acting PDL Edit || Opioid Prior Authorization 2575-021
Opioids – Short-Acting Clinical Edit || Opioid Prior Authorization 2575-021
Out-of-State, Non-Bordering Pharmacies Fiscal Edit
Oxervate Clinical Edit
Pancreatic Enzyme Agents PDL Edit
Parathyroid Hormone and Bone Resorption Suppression Related Agents Clinical Edit
Penicillin Agents PDL Edit
Phosphodiesterase (PDE) Inhibitors for Chronic Obstructive Pulmonary Disease (COPD) PDL Edit
Pompe Disease Clinical Edit
Primary Hyperoxaluria Clinical Edit (Formerly Oxlumo)
Prior Authorization Required Fiscal Edit
Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) Inhibitors PDL Edit
Proton Pump Inhibitors (PPIs) PDL Edit
Psoriasis Agents, Oral PDL Edit