PHARMACY BENEFITS MANAGEMENT (PBM) PROGRAM


Changes in Reimbursement Methodology for Louisiana Medicaid Pharmacy Fee for Service (FFS) Program - Effective October 1, 2014

Makena ® (Hydroxyprogesterone Caproate) Coverage for Louisiana Medicaid Pharmacy Program - Effective October 1, 2014

New Edits on Antipsychotic Medications for Louisiana Medicaid Pharmacy Program - Effective September 9, 2014

Third Party Liability (TPL) Payment Information for Louisiana Legacy Medicaid and Shared Health Plans - Effective October 15, 2014

Clarification of Edit on Anti-Anxiety Drugs for Louisiana Legacy Medicaid and Shared Health Plans

Revised RXPA Forms - Effective August 1, 2014

Hepatitis C Pre-authorization Provider Notice

Hydrocodone Prescriber to Prescriber Provider Notice

Pharmacy Providers RxPA Information Letter - Effective July 1, 2014

Preferred Drug List/Prior Authorization List
(Updated List from the April 30, 2014 Meeting - Effective July 1, 2014)

Preferred Drug List/Prior Authorization List
(Effective January 1, 2014)

Additional Edits on Victrelis® (boceprevir), Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir) for Louisiana Legacy Medicaid and Shared Health Plans - Effective May 30, 2014

Expansion of Diagnosis Code Requirements on Prescriptions for Louisiana Legacy Medicaid and Shared Health Plans - Effective May 30, 2014

NPI Requirements for Enrollment of Louisiana Legacy Medicaid and Shared Health Plans Pharmacy Providers - Effective July 1,2014

Edits on Victrelis® (boceprevir), Incivek® (telaprevir), Sovaldi® (sofosbuvir), and Olysio® (simeprevir) for Louisiana Legacy Medicaid and Shared Health Plans - Effective May 12, 2014

Coverage of Progesterone Vaginal Suppositories for Shared Plans and Legacy Medicaid - Effective April 21, 2014

Additional Limits on Hydrocodone-Containing Drugs for Shared Plans and Legacy Medicaid - Effective May 1, 2014

Edits on Anti-Anxiety Drugs for Louisiana Legacy Medicaid and Shared Health Plans - Effective April 16, 2014

Therapeutic Duplication of Antihistamines and/or Antihistamine Decongestant Combination Products for Louisiana Legacy Medicaid and Shared Health Plans - Effective April 1, 2014

Clinical Pre-Authorization Request for Granulocyte Colony Stimulating Factor Agents Granix®/Leukine®/Neulasta®/Neupogen® - Effective March 25, 2014

Clinical Pre-Authorization Request for Zyvox® (linezolid) Injection, Tablets, and Oral Suspension - Effective March 25, 2014

Expansion of Diagnosis Code Requirements on Prescriptions for LA Medicaid Shared Plans and Legacy Medicaid – Effective March 12, 2014

Maximum Daily Dosage Limit for Iloperidone (Fanapt®) for Recipients in Bayou Health Shared Plans and Legacy Medicaid - Effective February 20, 2014

Prescription Expiration for Non-Controlled Medications Policy Change for LA Medicaid Shared Plans and Legacy Medicaid - Effective January 1, 2014

Prior Authorization Requirement for Omalizumab (Xolair®) for Shared Plans and Legacy Medicaid- Effective October 15, 2013

LA Medicaid Shared Plans and Legacy Medicaid Pharmacy Policy Change for Therapeutic Duplication of Short-Acting Beta2 Agonist Inhalers - Effective October 1, 2013

Short-Acting Beta2 Agonist Inhalers and Omalizumab (Xolair®) Policy Changes for Bayou Health Shared Plans and Legacy Medicaid - Effective October 1, 2013

Proton Pump Inhibitors Duration of Therapy and Prior Authorization Override Requirements for Bayou Health Shared Plans and Legacy Medicaid - Effective July 1, 2013

Maximum Daily Dosage Limit for Selected Sedative Hypnotic Agents for Recipients in Bayou Health Shared Plans and Legacy Medicaid

Diagnosis Code Requirement for Reimbursement of Somatropin for Bayou Health Shared Plans and Legacy Medicaid

Maximum Daily Dosage Limit for Suboxone® and Subutex® - Effective February, 2013 (Physician)

Agents Added to Quantity Limit and Maximum Dosage Policy for Recipients in Legacy Medicaid Effective January 15, 2013 (Pharmacist) (Prescriber)

Attention All Pharmacy Providers - PBMs Associated with BAYOU HEALTH Pre-Paid Plans

Attention All Medicaid Pharmacy Providers - October 12, 2012

LA Medicaid Pharmacy Reimbursement Notice to Providers - October 29, 2012

Pharmacy Reimbursement Change - Effective September 5, 2012

Pharmacy Preferred Drug List (PDL) Online

Attention All Prescribing Providers February 1, 2012

To All Louisiana Pharmacies Effective February 1, 2012

Important Update on NCPDP D.0 and 5010 270/271 Transactions Implementation Effective January 1, 2012

Summary of Changes to the POS User Manual for November, 2011

Pharmacy Provider Outreach Article

Pharmacy Policy Update Letter 9/2/11

Attention Pharmacy Providers - Update on NCPDP D.0 Implementation

Flood 2011 – Pharmacy Provider Letter, May 13, 2011

Quantity Limits, Maximum Dosages and ICD-9-CM Diagnosis Code Requirement for C-II Narcotics
Quantity Limits on Triptans and Carisoprodol, and Maximum Dosage on Buprenorphine Patches - Pharmacists
Effective March 30, 2011

Quantity Limits, Maximum Dosages and ICD-9-CM Diagnosis Code Requirement for C-II Narcotics
Quantity Limits on Triptans and Carisoprodol, and Maximum Dosage on Buprenorphine Patches – Prescribing Providers
Effective March 30, 2011

Monthly Prescription Limit Letter – Pharmacists Effective December 1, 2010

Monthly Prescription Limit Letter – Prescribing Providers Effective December 1, 2010

Influenza Information

Reimbursement Criteria for Palivizumab (Synagis)

Pharmacy Provider Letter: Revised Louisiana Maximum Allowable Cost (LMAC) Reimbursement Methodology 1/27/10

Pharmacy Provider Letter: Suboxone®/Subutex® Criteria for Reimbursement

Physician Letter: Suboxone®/Subutex® Criteria for Reimbursement

Monthly Prescription Limit Letter - Pharmacists Effective May 1, 2009

Monthly Prescription Limit Letter - Prescribing Providers Effective May 1, 2009

Tamper-Resistant Prescription Pads Required October 1, 2008 08/29/08


eCDI Information for Medicaid Prescribing Practitioners

Prescribing Provider File (PPN)
(Zip file)
Listing of prescribing providers sorted by 
provider name.
Prescribing Provider File (PPN)
(Zip file)
Listing of prescribing providers sorted by 
provider type.

RXPA

Pharmacy Prior Authorization Program
Drug Appendices Drug lists identifying program pay status
DSM Program Disease State Management Program
Pharmacy Benefits Management Services Manual Provider manual containing policies and procedures needed to receive reimbursement for covered services provided to eligible Louisiana Medicaid recipients.
Point of Sale (POS) User Guide User Manual for the Pharmacy Point of Sale Program.
POS Vendor Specs Document Vendor Specifications Document for the POS Adjudication System.
POS Vendor Specs Appendices Vendor Specifications Appendices for the POS Adjudication System.
Provider/Recipient Correspondence Letters and updates sent to pharmacy and prescribing providers and Medicaid recipients

The LMMIS  Pharmacy Benefits Management (PBM) Program has responsibility for the coordination of  all  Medicaid  pharmacy-related services.   Services include:

Other services available to pharmacy providers include:

The PA process is supported by the operations of the University of Louisiana at Monroe College of Pharmacy (ULM) Prior Approval  Desk.

For more information on specific components of the Pharmacy Benefits Program, click on the “bold faced” services noted above.