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 |
| May 16, 2011 |
5-HT1 Agonist (Triptan) Therapy-PDL |
| Jul 27, 2011 |
5HT3 Receptor Antagonists-PDL |
| May 16, 2011 |
ACE Inhibitors-PDL |
| May 16, 2011 |
ACE Inhibitors/Calcium Channel Blocker Combinations-PDL |
| Mar 24, 2003 |
Actiq Lozenges |
| Aug 5, 2010 |
ADHD Therapy |
| Jul 07, 2003 |
Alinia (Nitazoxanide)/antiparasitic/antimicrobial) |
| May 16, 2011 |
Alpha-GlucosidaseInhibitors-PDL |
| May 16, 2011 |
Alzheimer’s Agents (Cholinesterase Inhibitors) -PDL |
| Oct 14, 2010 |
Amylin Analogs-PDL |
| Dec 19, 2006 |
Amitiza® |
| Jul 07, 2011 |
Ampyra |
| Jul 20, 2011 |
Androgen Hormone Inhibitor-PDL |
| May 16, 2011 |
Angiotensin II Receptor Blocker Diuretic Combinations-PDL |
| May 16, 2011 |
Angiotensin II Receptor Blockers-PDL |
| Jul 29, 2003 |
Antibiotic RTU Pack |
| Jun 22, 2011 |
Antihyperuricemic Agents-PDL |
| Oct 21, 2010 |
Atypical Antipsychotics |
| Jul 20, 2011 |
Beta Adrenergic Agents Long Acting - PDL |
| Jul 20, 2011 |
Beta Adrenergic Agents Short Acting - PDL |
| Jul 20, 2011 |
Beta Adrenergic Agents/Nebulized - PDL |
| Oct 14, 2010 |
Beta Adrenergic Blockers- PDL |
| Nov 09, 2006 |
BiDil® Tablets |
| May 16, 2011 |
Biguanides-PDL |
| Jun 27, 2011 |
Bile Salts Agents-PDL |
| May 16, 2011 |
Bone Deossification Suppression Agents - PDL |
| Jun 10, 2011 |
Botulinum Toxin Type A (Botox) |
| Jul 05, 2011 |
Butorphanol |
| Oct 14, 2010 |
Calcium Channel Blockers (DHP)-PDL |
| Oct 14, 2010 |
Calcium Channel Blockers (nonDHP)-PDL |
| Oct 14, 2010 |
Calcium Channel Blockers/ARBS-PDL |
| Jul 29, 2003 |
Cold Sore Treatment Fiscal Edit |
| Nov 17, 2005 |
Combunox® Tablets |
| Jul 20, 2011 |
COPD Anticholinergics -PDL |
| Oct 14, 2010 |
COX-2 Inhibitors -PDL |
| May 16, 2011 |
Cryopyrin-Associated Periodic Syndrome (CAPS) Agents-PDL |
| Jul 20, 2011 |
Direct Renin Inhibitors -PDL |
| Jul 20, 2011 |
Disease-Modifying AntiRheumatic Drug (DMARD) - PDL |
| Nov 13, 2003 |
Dolgic LQ® (Acetaminophen/Butalbital/Caffeine) |
| Oct 14, 2010 |
DPP-IV Inhibitors-PDL |
| May 16, 2011 |
Electrolyte Depleters-PDL |
| May 16, 2007 |
Emsam® |
| Jan 19, 2006 |
Equetro® |
| May 16, 2011 |
Fibromyalgia Agents |
| Jul 29, 2003 |
Fluconazole (Diflucan) |
| May 16, 2011 |
FluoroQuinolones-Oral-PDL |
| Jul 28, 2003 |
Forteo® (teriparatide injection / Parathyroid Hormone) |
| Jul 07, 2003 |
Geodon for Injection (ziprasidone mesylate)/Atypical Antipsychotic Agents, Injectible |
| Oct 14, 2010 |
GLP-1 Receptor Agonists -PDL |
| Jul 13, 2010 |
Growth Hormones-PDL |
| Jul 07, 2003 |
H2 Antagonists |
| Jul 20, 2011 |
Hematopoietic Agents |
| Oct 14, 2010 |
Hepatitis C Therapy-PDL |
| May 16, 2011 |
Herpes Antivirals-PDL |
| Jul 20, 2011 |
HMG-Co A reductase inhibitors (statins) -PDL |
| Dec 11, 2003 |
H-Pylori Therapy |
| Jul 07, 2011 |
Human Papillomavirus Vaccines |
| Jun 22, 2011 |
Inhaled Antibiotics-PDL |
| Feb 28, 2011 |
Inhaled Corticosteroids - PDL |
| Jul 20, 2011 |
Insulin Mix-PDL |
| Jul 20, 2011 |
Insulin Rapid Acting-PDL |
| Jul 20, 2011 |
Insulins-PDL |
| Jul 20, 2011 |
Insulins Long Acting-PDL |
| Jul 20, 2011 |
Intranasal Antihistamines-PDL |
| May 16, 2011 |
Intranasal Steroids - PDL |
| May 16, 2011 |
Intravaginal Antibiotics - PDL |
| Nov 13, 2003 |
Klonopin Wafer® (clonazepam) |
| Nov 07, 2003 |
Lactulose Step Therapy Edit |
| May 16, 2011 |
Leukotriene-PDL |
| Jul 20, 2011 |
Low Molecular Weight Anticoagulants |
| May 16, 2011 |
Macrolides-PDL |
| May 16, 2011 |
Meglintinides - PDL |
| Aug 25, 2010 |
Megestrol Acetate |
| Nov 03, 2004 |
Methadone |
| Nov 12, 2009 |
Miralax |
| Aug 05, 2011 |
Multiple Sclerosis Agents-PDL |
| May 16, 2011 |
Narcotics, Long Acting - PDL |
| Feb 02, 2012 |
Narcotics, Short Acting |
| Feb 09, 2012 |
Narcotics, Short Acting Combinations |
| May 16, 2011 |
Niacin Preparations - PDL |
| Jul 20, 2011 |
Non-Ergot Dopamine Receptor Agonists-PDL |
| Jan 26, 2012 |
Non-Oral Contraceptives Fiscal Edit |
| May 16, 2011 |
Non-Sedating Antihistamines-PDL |
| Aug 24, 2010 |
NSAID Step Therapy Edit |
| May 03, 2007 |
Nubain® |
| Oct 14, 2010 |
Onychomycosis Antifungal Agents-PDL |
| Jun 20, 2007 |
Opana® Immediate-Release Tablets |
| May 16, 2011 |
Ophthalmic Antihistamines-PDL |
| May 16, 2011 |
Ophthalmic Mast Cell Stabilizers-PDL |
| Jul 20, 2011 |
Ophthalmic NSAIDs-PDL |
| May 16, 2011 |
Ophthalmic Prostaglandin Agonists PDL |
| May 16, 2011 |
Oral AntiDiabetics: Combinations-PDL |
| May 16, 2011 |
Otic Quinolones-PDL |
| Jan 31, 2005 |
Oxandrin® |
| June 27, 2011 |
Pancreatic Enzyme Agents-PDL |
| Sep 09, 2010 |
Platelet Inhibitor-PDL |
| Sep 26, 2005 |
Prostin VR® Pediatric |
| Oct 14, 2010 |
Proton Pump Inhibitor-PDL |
| Nov 12, 2010 |
Psychotropic Medications Polypharmacy |
| Jun 8, 2010 |
Pulmonary Hypertension Agents-PDL |
| May 16, 2011 |
Pulmonary Hypertension Agents (Oral)-PDL |
| May 16, 2011 |
Quinolone Ophthalmic Antibiotic-PDL |
| Jul 07, 2011 |
Ranexa® |
| Jan 12, 2005 |
Raniclor™ |
| Dec 23, 2004 |
Raptiva |
| Jun 22, 2005 |
Retinoic Acid Products/Retinoid Analogues - Topical |
| Oct 14, 2010 |
Ribavirins - PDL |
| Jul 20, 2011 |
Sedative Hypnotics-PDL |
| Dec 08, 2010 |
Selective Serotonin Reuptake Inhibitor (SSRI) |
| May 16, 2011 |
Self Injecting Epinephrine Agents |
| Jul 07, 2011 |
Selzentry® (Maraviroc) |
| Nov 18, 2010 |
Serotonin-Norepinephrine Reuptake Inhibitors (SNRI) |
| Sep 08, 2010 |
Skeletal Muscle |
| Feb 25, 2011 |
Smoking Cessation |
| Jun 20, 2011 |
Suboxone |
| Jul 29, 2003 |
Sucralfate (Carafate) |
| May 16, 2011 |
Sulfonylureas-PDL |
| Sep 16, 2010 |
Synagis (palivizumab) |
| May 12, 2006 |
Tamiflu® |
| Jul 07, 2003 |
Thalomid (thalidomide) |
| May 16, 2011 |
Thiazolidinediones - PDL |
| Oct 29, 2007 |
Tindamax® |
| Jan 19, 2010 |
Topical Agents for Psoriasis - PDL |
| Oct 14, 2010 |
Topical Androgenic Agents |
| Jul 20, 2011 |
Topical Benzoyl Peroxide/Clindamycin Combination |
| Oct 14, 2010 |
Topical Immunomodulators - PDL |
| Jul 20, 2011 |
Topical Retinoids - PDL |
| Jul 20, 2011 |
Tramadol Like Agents-PDL |
| Jan 16, 2004 |
Tricyclic Antidepressant Coordination of Care |
| Jul 20, 2011 |
TriGlyceride Lower Agents-PDL |
| May 16, 2011 |
Ulcerative Colitis Oral Agents-PDL |
| May 16, 2011 |
Ulcerative Colitis-Rectal-PDL |
| Jul 20, 2011 |
Urinary Tract Antispasmodics - PDL |
| Apr 15, 2009 |
Vivitrol ® |
| Mar 07, 2003 |
Voriconazole (Vfend) / Antifungal |
| Nov 13, 2003 |
Xanax XR® (Alprazolam) |
| Dec 30, 2009 |
Xolair |
| Nov 13, 2003 |
Zometa® (zoledronic acid) |
| Apr 11, 2007 |
Zostavax Injection |
| Jan 13, 2005 |
Zyprexa IM® |