Preferred Drug List & Utilization Managment Edits

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 Antifungals Topical PDL 7-9-26
Antihistamines and Antihistamine/Decongestant Combinations, 2nd Generation PDL Edit Antihist Decongest Combo 2nd Gen PDL 7-9-26
Antihistamines, Intranasal PDL Edit Antihistamines Intranasal PDL 7-9-26
Antihistamines, Ophthalmic PDL Edit Antihistamines Ophth PDL 7-9-26
Antihyperuricemic Agents PDL Edit
Antiparasitics, Topical PDL Edit Antiparasitics Topical PDL 07-9-25
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 Herpes Oral PDL 7-9-26
Antivirals, Topical PDL Edit Antivirals Topical Herpes Labialis PDL 7-9-26
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 Benzoyl Perox Abx Combo PDL 7-9-26
Besremi Clinical Edit
Beta Adrenergic Agents, Long Acting PDL Edit Beta Adrenergic Long Acting PDL 7-9-26
Beta Adrenergic Agents, Nebulized PDL Edit Beta Adrenergic Neb PDL 7-9-26
Beta Adrenergic Agents, Short Acting PDL Edit Beta Adrenergic Short Acting PDL 7-9-26
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