PHARMACY BENEFITS MANAGEMENT (PBM) PROGRAM
Preferred Drug
List/Prior Authorization List
(Update list from the February 10, 2010 P&T Committee Meeting - Effective April 1, 2010)
LADUR Region 2 Committee Physician Nomination Form 6/22/10
H1N1 Influenza Information 4/20/10
Update to Reimbursement Criteria for Palivizumab (Synagis) 3/18/10
Pharmacy Provider Letter: Revised Louisiana Maximum Allowable Cost (LMAC) Reimbursement Methodology 1/27/10
Reimbursement of H1N1 Vaccine Administration – Pharmacists Effective October 10, 2009
Criteria for Reimbursement of Synagis®, Antipsychotic Agents, and Agents Used to Treat ADD - Pharmacists Effective October 1, 2009
Criteria for Reimbursement of Synagis®, Antipsychotic Agents, and Agents Used to Treat ADD - Prescribing Providers Effective October 1, 2009
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 The LMMIS Pharmacy
Benefits Management (PBM) Program has responsibility for the coordination of all Medicaid
pharmacy-related services. Claim Processing of
15, 000, 000 Rx/year through Point of Sale Clinical/policy claim
editing Prospective and Retrospective Drug Utilization Review
Programs (DUR) Pharmacy Help Desk Services Recipient Disease state brochures Provider Disease state brochures Drug rebate program Post payment reviews
Other services available to pharmacy providers include: Electronic Remittance Advices Data warehouse support services Reference file maintenance 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.
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.
Pharmacy Prior Authorization
Program
Drug Appendices
Drug lists identifying program pay
status
DSM Program
Disease State Management Program
Pharmacy
Benefits Management Services, Chapter 37 - Updated February 19, 2010
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. Revised 6/10
POS
Vendor Specs Document
Vendor Specifications Document for
the POS Adjudication System. Revised 3/10
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