Pharmacy Index

PHARMACY BENEFITS MANAGEMENT (PBM) PROGRAM


eCDI Information for Medicaid Prescribing Practitioners
ICD-10-CM Diagnosis Code Policy Chart Listing of medications requiring submission of diagnosis code(s) at Point of Sale (POS).
Prescribing Provider File (PPN)
(Zip file)
Listing of prescribing providers sorted by 
provider name.
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

Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List

Pharmacy Providers RxPA Information Letter - Effective April 1, 2021

Louisiana Medicaid Pharmacy Single Preferred Drug List (PDL) Update for Dulaglutide (Trulicity®) Pen Injector - Effective April 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirements for Select Drugs- Effective April 7, 2021

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization for Select Drugs- Effective April 7, 2021

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for April 2021 - Effective April 7, 2021

Louisiana Medicaid Pharmacy Johnson & Johnson (Janssen) COVID-19 Vaccine Coverage - Effective February 27, 2021

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirements for Select Drugs - Effective January 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Prior Use Edit for Cariprazine (Vraylar®) and Lurasidone (Latuda®) – Effective January 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Clinical Updates and Therapeutic Duplication for Agalsidase Beta (Fabrazyme®) and Migalastat (Galafold®) - January 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization for Select Drugs - Effective January 1, 2021

Louisiana Medicaid Pharmacy COVID-19 Vaccine Coverage - Effective December 23, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Quantity Limit Edits - Effective January 1, 2021

Pharmacy Providers RxPA Information Letter - Effective January 1, 2021

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits - Effective October 7, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement for Select Medications - Effective October 7, 2020

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization for Select Drugs - Effective October 7, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) NCPDP 460-ET Quantity Prescribed Reporting for all Schedule II Drugs – Effective September 21, 2020

Louisiana Medicaid Pharmacy Adult Vaccine Coverage Policy Update - Effective September 15, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement for Select Medications - August 3, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Quantity Limits - August 3, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Lumateperone (Caplyta™) - August 3, 2020

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization for Select Drugs - August 3, 2020

Louisiana Medicaid Pharmacy Adult Vaccine Coverage - Effective July 1, 2020

Pharmacy Providers RxPA Information Letter - Effective July 1, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Asenapine (Secuado®) - Effective May 15, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for May 2020 - Effective May 15, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Clinical Edits for March 2020

Louisiana Medicaid Pharmacy Billing for Brand Name Drugs - Effective February 1, 2020

Louisiana Medicaid Pharmacy Lock-In Program

Louisiana Medicaid Fee for Service (FFS) and Managed Care Organizations (MCOs) Assessment of Updated Pharmacy Copayments - Effective January 1, 2020

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement and Quantity Limits for Sumatriptan Nasal Spray (Tosymra®) - Effective December 15, 2019

Louisiana Medicaid Updated Clinical Edits for Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) and Antidepressant Medications - Effective December 1, 2019

Louisiana Medicaid Pharmacy Point of Sale (POS) Clinical Authorization for Select Drugs - Effective December 1, 2019

Louisiana Medicaid Pharmacy Point of Sale (POS) Clinical Authorization for Onasemnogene Abeparvovec Injection (Zolgensma®), Risankizumab Injection (Skyrizi®), and Revision of POS Edits for Androgens Effective November 1, 2019

Louisiana Medicaid Fee for Service (FFS) Pharmacy and Managed Care Organizations (MCOs) Suspending Agents Coverage - Effective November 1, 2019

Diagnosis Code Requirements for Antiretroviral Agents, Agalsidase Beta (Fabrazyme ®), Alglucosidase (Lumizyme®), Amikacin (Arikayce®), and Eculizumab (Soliris®) - Effective November 1, 2019

Louisiana Medicaid Quantity Limits for Opioid Liquids, Collagenase Topical (Santyl®), and Galcanezumab Injection (Emgality®) - Effective November 1, 2019

Pharmacy Point of Sale (POS) Revised Duration of Therapy Edit for Proton Pump Inhibitors (PPIs) and H2 Antagonists - Effective November 1, 2019

Louisiana Medicaid Preferred Drug List (PDL)/Non-Preferred Drug List Effective October 1, 2019

Louisiana Fee for Service (FFS) Medicaid Educational Alert for Concurrent Use of Opiates and Antipsychotic Agents - Effective October 1, 2019

Louisiana Medicaid Updated Clinical Edits for Antipsychotic Agents - Effective October 1, 2019

Louisiana Medicaid Updated Opioid Clinical Edits - Effective October 1, 2019

Louisiana Fee for Service (FFS) Medicaid Updated 340B Billing Policy - Effective August 5, 2019

Point of Sale (POS) Therapeutic Duplication for Antipsychotic Pharmacy Claims and Diagnosis Code Requirement for Progesterone (Crinone®) and Tobramycin (Kitabis®)- Effective August 1, 2019

Updated Single Preferred Drug List (PDL) for Select Drugs – Effective August 1, 2019

July 2019 Tropical Storm Barry Information for Medicaid Pharmacy

Pharmacy Providers RxPA Information Letter - Effective July 1, 2019

Hepatitis C Virus Direct Acting Antiviral (DAA) Agent Update – Effective July 15, 2019

Updated Single Preferred Drug List (PDL) for Elagolix (Orilissa®), Ivabradine (Corlanor®), Ergotamines, and Calcitonin Gene-Related Peptide (CGRP) Antagonists – Effective July 1, 2019

Updated Single Preferred Drug List (PDL) for Acne Treatment Agents – Effective July 1, 2019

Louisiana Medicaid Pharmacy Copayments (Recipient Notice) - Effective April 1, 2019

Louisiana Medicaid Updated Pharmacy Reimbursement Policy for Fee for Service (FFS) and Managed Care Organizations (MCO) Local Pharmacies – Effective May 1, 2019

Fee for Service (FFS) Clinical Pre-Authorization for Methadone and FFS and Managed Care Organizations (MCOs) Maximum Daily Dose Update for Buprenorphine - Effective May 1, 2019

Louisiana Medicaid Fee for Service (FFS) Pharmacy Point of Sale (POS) Updated Age Requirements for Perampanel (Fycompa®) - Effective April 18, 2019

Louisiana Medicaid Fee for Service (FFS) and Managed Care Organizations (MCOs) Assessment of Updated Pharmacy Copayments - Effective April 1, 2019

Louisiana Medicaid Fee for Service (FFS) Pharmacy Point of Sale (POS) Clinical Pre-Authorization for New Granulocyte Colony Stimulating Factor (GCSF) Agents and Updated POS Diagnosis Codes for IncobotulinumtoxinA (Xeomin®) - Effective March 14, 2019

Additional Pharmacy Policies

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

  • Claim Processing through Point of Sale
  • Clinical/policy claim editing
  • Prospective and Retrospective Drug Utilization Review Programs (DUR)
  • Pharmacy Help Desk Services
  • Recipient Lock In Program
  • Federal and Supplemental Drug Rebate Program
  • Post payment reviews
  • Encounter Capture from MCO claims

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.

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