 September 29, 2023
Pharmacy Updates and Edits MO HealthNet is required to complete an annual review of all drug coverage criteria per 13 CSR 70-20.200 Drug Prior Authorization Process. Web page:https://dss.mo.gov/mhd/cs/pharmacy/pages/clinedit.htm Annual Renewal Effective: 10/05/2023 Alpha-Glucosidase Inhibitors Amylin Analogs PDL Atopic Dermatitis Agents, Immunomodulators PDL Edit Biguanides & Combination Agents PDL Biosimilar vs Reference Products Fiscal Edit Colony Stimulating Factors PDL Cryopyrin-Associated Periodic Syndrome (CAPS) Agents PDL Dose Optimization Fiscal Edit DPP-IV Inhibitors PDL Erythropoiesis Stimulating Agents PDL Glucagon Agents PDL Growth Hormones & Growth Hormone Releasing Factors, Select Agents PDL Growth Hormones Somatropin Agents PD Insulins Long Acting PDL Insulins Mix PDL Insulins-Non-Analog PDL Insulins Rapid Acting PDL Luteinizing Hormone Releasing Hormone (LHRH)/Gonadotropin Releasing Hormone (GnRH) Agents, Non-Oral PDL Luteinizing Hormone Releasing Hormone (LHRH)/Gonadotropin Releasing Hormone (GnRH) Agents, Oral PDL Meglitinide Agents PDL Methotrexate Agents PDL Multiple Sclerosis, Injectable Agents PDL Multiple Sclerosis, Oral Agents PDL Prior Authorization Required Fiscal Edit Psoriasis Agents - Oral PDL Psoriasis Agents – Topical PDL Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors & Combination Agents PDL Sulfonylurea Agents, Second Generation PDL Targeted Immune Modulators, IL-17A Antibody/IL-17 Receptor Antagonists PDL Targeted Immune Modulators, IL-23 Inhibitors & IL-23/IL-12 Inhibitors PDL Targeted Immune Modulators, Interleukin-6 (IL-6) Receptor Inhibitors PDL Targeted Immune Modulators, Janus Kinase (JAK) Inhibitors PDL Targeted Immune Modulators, Misc. Allergy and Asthma Related Monoclonal Antibodies PDL (formerly Respiratory Monoclonal Antibody PDL) Targeted Immune Modulators, Select Agents PDL Targeted Immune Modulators, Tumor Necrosis Factor (TNF) Inhibitors PDL Thiazolidinediones & Combination Agents PDL Thromobocytopenia Agents PDL Urinary Tract Antispasmodics PDL New Edit Effective: 10/05/2023 Bleeding Disorder Agents PDL Annual Renewal Effective: 10/06/2023 Fluoroquinolones – Otic PDL
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