LETTER TO PRESCRIBING PRACTITIONERS
October 20, 2005
PDL # 05-02
Monthly Script Limit
Attached is the
complete, most current listing of drugs on the Medicaid Prior Authorization (PA)
Process’ Preferred Drug List (PDL) “05-02.”
The listing includes preferred drugs and those drugs requiring prior
list will be effective November 1, 2005.
The PA process,
in accordance with the program’s “Continuity of Care” policy, does not
impact original prescriptions (or refills) issued by a prescribing practitioner
prior to effective PA dates of drugs as they are added to the PA process as
long as they are within the 5 refills and 6-month program limits. An
educational alert will notify the pharmacist that prescriptions (and their
refills) will require a new prescription and prior authorization, if the
prescription life exceeds six months or the refill exceeds the 5 refill limit.
The educational alert will state, “NEW RX WILL REQUIRE PA AFTER (DATE).”
the Prior Authorization process, including the PDL and Prior Authorization
Request Form (copy is attached, Form RXPA01), is also available on the Louisiana
Medicaid website (www.lamedicaid.com).
This website will be updated when changes (additions or deletions) are made to
the PDL. The program may also utilize the provider remittance advices to notify
providers of PDL changes that must be implemented in short time frames.
has received inquiries that drug products requiring PA are not reimbursable by
Medicaid. Medicaid does reimburse for drug products requiring prior
authorization when the prior authorization process is followed.
177 of the 2005 Regular Session of the Louisiana Legislature authorizes
the Department of Health and Hospitals to review atypical antipsychotic and
hepatitis C drugs for placement on the Medicaid Preferred Drug List (PDL).
These drugs were reviewed at the August 17, 2005, Pharmaceutical and
Therapeutics Committee meeting and are included on the current PDL #05-02.
The legislation contains a “grandfathering” provision which provides
for the following: Medicaid
recipients that have had a prescription filled for an atypical antipsychotic or
hepatitis C drug from May 1 – October 31 (six months prior to the effective
date of the drug class being placed on the PDL) will not need to obtain
prior authorization for their drug if the drug that they are currently taking
should be non-preferred.
Discharge Prescriptions for Atypical Antipsychotics:
When a recipient is discharged from a hospital with a prescription
for an atypical antipsychotic prescription, the prescribing practitioner must
indicate on the face of the prescription, if hard copy, that the prescription is
a “Hospital Discharge” or if the prescription is called in
to the pharmacy, the “Hospital Discharge” status of the prescription must be
communicated to the pharmacist who must indicate “ Hospital Discharge” on
the hard copy prescription.
In situations where the prescribing
practitioner is unavailable and the pharmacist determines the prescription is a
“Hospital Discharge” prescription, the pharmacist must indicate “Hospital
Discharge” on the hard copy prescription.
Prescriptions for “Hospital Discharge”
products shall be dispensed in a MINIMUM quantity of a 3-day supply, and refills for the dispensing of the
non-preferred products are not permitted.
The recipient’s practitioner
must contact the Prior Authorization Unit to request authorization to continue
the medication past the “Hospital Discharge” supply, and a new prescription
must be issued.
DHH will monitor
emergency prescriptions/recipients on an ongoing basis through management
reports, pharmacy provider audits, and other review programs to review the
number of these prescriptions and the reasons for them.
The monthly script limit edit was
temporarily suspended for Hurricane Katrina.
Please note that effective November 1, 2005, the monthly script limit
edit will be reactivated.
Thank you for
your continued cooperation. We appreciate your participation in the Medicaid
Ben A. Bearden
The above letter and the Preferred Drug List are also available in PDF format on the Downloadable Forms and Files page.