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)

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, 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

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

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 Lock In Program
Disease Management Programs
Recipient Disease state brochures
Provider Disease state brochures
Drug rebate program
Post payment reviews

Other services available to pharmacy providers include:

Provider Relation Services
- Regional provider service representatives
- Regional training programs
Provider Update newsletter educational programs
Electronic Funds Transfer (EFT)
Electronic Remittance Advices
Provider enrollment
Data warehouse support services
Reference file maintenance
Prior Approval Program (PA)

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.

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, 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