MO HealthNet Pharmacy Program announces provider update

The MO HealthNet Division offers health care coverage for eligible Missourians. If you do not currently have health care coverage through MO HealthNet, the Family Support Division can assist you with your application.

The MO HealthNet Pharmacy Program has been notified that brand name Flovent HFA® will be discontinued by the manufacturer.

In response to this change in the marketplace and after consultation with several MO HealthNet providers, the following updates to the Corticosteroids, Oral Inhaled PDL Edit are effective

11/02/2023:
No change:
Flovent HFA® will remain a preferred agent to allow current supply in the marketplace to be utilized.
Fluticasone Propionate HFA (generic Flovent HFA®) will remain a non-preferred agent.

New preferred DPI agents added to the PDL listing:
Arnuity® Ellipta® (fluticasone furoate) is now a preferred agent.
Asmanex® Twisthaler® (mometasone furoate) is now a preferred agent.

MO HealthNet recognizes that pediatric patients may not have the ability to coordinate and generate the inspiratory flow rate necessary to effectively deliver the medication from a DPI. Therefore, participants < 12 years of age may access the following MDI agents as first line therapy without any pre-requisite trial of a preferred agent:

Asmanex® HFA (mometasone furoate)
Dulera® 50mcg/5mcg (mometasone furoate and formoterol fumarate dihydrate)
Please reference the full criteria at Corticosteroids-Oral-Inhaled-New.pdf (mo.gov).

MO HealthNet continues to recommend the use of SMART therapy for all appropriate participants with asthma.

Symbicort® and Dulera® 100mcg/5mcg continue to remain preferred agents with no prior authorization required. More information on SMART therapy may be accessed here: MO HealthNet Asthma SMART Flyer (8.5 x 11 in).

Providers with questions may call MO HealthNet at 800-392-8030.

MO HealthNet is required to complete an annual review of all drug coverage criteria per 13 CSR 70-20.200 Drug Prior Authorization Process.
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: 01/11/2024

ACE Inhibitors and ACE Inhibitors/Diuretic Combinations PDL

ACE Inhibitor/Calcium Channel Blocker Combinations PDL

ADHD, Amphetamines Long Acting PDL

ADHD, Amphetamines Short Acting PDL

ADHD, Methylphenidate Long Acting PDL

ADHD, Methylphenidate Short Acting PDL

ADHD, Non-Stimulants PDL

Angiotensin Receptor Blockers and Angiotensin Receptor Blocker/Diuretic Combinations PDL

Angiotensin Receptor Blocker-Calcium Channel Blocker Combinations PDL

Anticoagulants: Oral and Subcutaneous PDL

Anticonvulsants, Rescue Agents PDL

Antihyperuricemic Agents PDL

Antiplatelet Agents PDL

Benign Prostatic Hyperplasia Agents PDL Edit

Beta Andrenergic Agents – Short Acting

Beta Adrenergic Blockers and Beta Adrenergic Blockers-Diuretic Combinations PDL

Bile Salts Agents PDL

Bone Ossification Agents PDL

Brand Over Generic Fiscal Edit

Calcium Channel Blockers (Dihydropyridines) PDL

Calcium Channel Blockers (Non-Dihydropyridines) PDL

Direct Renin Inhibitors and Combinations PDL

Electrolyte Depleting Agents, Phosphate Lowering PDL

Electrolyte Depleting Agents, Potassium Lowering PDL

Enzyme Deficiency, Select Agents Clinical Edit

Homozygous Familial Hypercholesterolemia (HoFH) Agents PDL

Insulins Long Acting PDL

Insulins Mix PDL

Insulins Rapid Acting PDL

Keratoconjunctivitis Agents PDL (formerly Dry Eye Disease Agents)

Niacin Derivatives PDL

Prior Authorization Required Fiscal Edit

Proprotein Convertase Subtilisin Kexin Type 9 (PCSK9) Binder PDL

Proton Pump Inhibitors PDL

Pulmonary Arterial Hypertension (PAH) Agents, Endothelin Receptor Antagonists (ETRAs) PDL

Pulmonary Arterial Hypertension (PAH) Agents, Phosphodiesterase-5 (PDE5) and Soluble Guanylate Cyclase (SGC) Stimulators PDL)

Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Inhaled PDL

Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Injectable PDL

Pulmonary Arterial Hypertension (PAH) Agents, Prostacyclin Pathway Agonists, Oral PDL

Statins (HMG Co-A Reductase Inhibitors) and Combination Products PDL

Sympatholytics PDL Edit

Triglyceride Lowering Agents PDL

Voxzogo Clinical Edit

New Edit Effective: 01/11/2024

Mineralocorticoid Receptor Antagonists PDL Edit

Urea Cycle Disorder Agents PDL Edit

Contact Us
For questions about pharmacy or MORx, please email: MHD.PharmacyAdmin@dss.mo.gov.
For questions about psychology, exceptions, or medical pre-certifications, please email: Clinical.Services@dss.mo.gov

For all other questions or comments, please email: Ask.MHD@dss.mo.gov