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

Louisiana Medicaid Pharmacy COVID-19 Vaccines Administration Rate Update – Effective November 1, 2024

Louisiana Medicaid Pharmacy Beneficiary Third Party Liability Data Migration for Pharmacy Claims - November 2024

Louisiana Medicaid Pharmacy Updated Criteria for GLP-1 Receptor Agonists – Effective November 15, 2024

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits – Effective October 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement – Effective October 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Edits for Macitentan/Tadalafil (Opsynvi®) and Semaglutide (Wegovy®) – Effective October 1, 2024

Louisiana Medicaid Pharmacy Coverage Update for At-Home Over the Counter (OTC) COVID-19 Diagnostic Tests - 2nd Revision Effective September 30, 2024

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates – Effective October 1, 2024

August 2024 Tropical Storm Francine Information for Medicaid Pharmacy

Louisiana Medicaid Pharmacy Coverage Update for At-Home Over the Counter (OTC) COVID-19 Diagnostic Tests *Revised - Effective October 1, 2024

Louisiana Medicaid Pharmacy Coverage Update for At-Home Over the Counter (OTC) COVID-19 Diagnostic Tests Effective - September 30, 2024

Louisiana Medicaid Pharmacy Coverage Update for COVID Treatment Nirmatrelvir/Ritonavir (PaxlovidTM) - Effective October 1, 2024

Louisiana Medicaid Pharmacy New Copay Tier

Louisiana Medicaid Pharmacy Diagnosis Code Policy Reminder

Louisiana Medicaid Pharmacy Clinical Authorization for Semaglutide (Wegovy®) - Effective July 1, 2024

Louisiana Medicaid Pharmacy Single Preferred Drug List (PDL) Update – Effective July 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Edits for Vonoprazan (Voquezna®), Sitagliptin (Zituvio™), and Budesonide (Eohilia™)– Effective July 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates– Effective July 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Quantity Limit – Effective July 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement – Effective July 1, 2024

Louisiana Medicaid Pharmacy Reimbursement Policy

Louisiana Medicaid Pharmacy Point of Sale Quantity Limit - Effective April 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Age Requirements - Effective April 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Edits for Therapeutic Duplication and Prior Use - Effective April 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement - Effective April 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates - Effective April 1, 2024

Louisiana Medicaid Pharmacy Compound Drug Coverage for Managed Care Organizations (MCOs) - Effective April 1, 2024

Louisiana Medicaid Pharmacy Clotting Factor Products Update

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement - Effective January 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates - Effective January 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Edits for Buprenorphine Extended-Release Injection (Brixadi™) - Effective January 1, 2024

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective January 1, 2024

Louisiana Medicaid Pharmacy Professional Dispensing Fee Change - Effective January 1, 2024

Pharmacy Providers RxPA Information Letter - Effective January 1, 2024

Louisiana Medicaid Pharmacy COVID-19 Vaccines 2023-2024 Point of Sale (POS) Billing Update - Effective October 28, 2023

Louisiana Medicaid Pharmacy Diabetic Supplies Reimbursement Update - Effective December 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates - Effective October 28, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Maximum Duration of Therapy - Effective October 28, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Drug-Drug Interaction - Effective October 28, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Prior Use Requirement - Effective October 28, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Therapeutic Duplication- Effective October 28, 2023

Louisiana Medicaid Pharmacy Point of Sale Diagnosis Code Requirement - Effective October 28, 2023

Louisiana Medicaid Pharmacy COVID-19 Vaccines 2023-2024 Reimbursement Update

Louisiana Medicaid Pharmacy Diabetic Supplies on the Preferred Drug List (PDL) for Outpatient Pharmacy Services - Effective October 28, 2023

Louisiana Medicaid Pharmacy Counseling for Vaccines - Implementation Postponed to October 28, 2023

Louisiana Medicaid Pharmacy COVID-19 Vaccines 2023-2024 Update

Louisiana Medicaid Pharmacy Maintenance Medications Professional Dispensing Fee for Managed Care Organizations (MCOs) – Implementation Postponed to October 28, 2023

Single Pharmacy Benefits Manager for Managed Care Organizations Original Implementation has been Postponed - Effective October 1, 2023

Louisiana Medicaid Pharmacy Adult Vaccine Coverage Policy Update - Effective August 1, 2023

Pharmacy Providers RxPA Information Letter - Effective July 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective July 1, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement - Effective July 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates - Effective July 1, 2023

End of Public Health Emergency (PHE) for COVID-19 Pharmacy Updates - Effective May 12, 2023

Louisiana Medicaid Pharmacy 90-Day Supply Allowance for Select Maintenance Medications - Effective April 1, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement - Effective April 1, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits - Effective April 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates - Effective April 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits and Maximum Daily Dose - Effective April 2023

Louisiana Medicaid Pharmacy COVID-19 Update - Effective March 14, 2023

Louisiana Medicaid Pharmacy COVID-19 Vaccine Update - Effective January 6, 2023

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits – Effective January 1, 2023

Louisiana Medicaid Fee for Service (FFS) Pharmacy Claims Prior Authorization Adds Humana Healthy Horizons - Effective January 1, 2023

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Daridorexant (Quviviq™) - Effective January 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Edits and Clinical Updates for Select Medications - Effective January 1, 2023

Louisiana Medicaid Pharmacy Point of Sale Dispensing of Contraceptives - Effective January 1, 2023

Pharmacy Providers RxPA Information Letter - Effective January 1, 2023

Humana Healthy Horizons - Effective January 1, 2023

Louisiana Medicaid Pharmacy COVID-19 Vaccine Update: FDA Emergency Use Authorization for COVID-19 Bivalent Booster in Children - Effective October 12, 2022

Louisiana Medicaid Fee for Service (FFS) Electronic Drug Prior Authorization (E-PA) - Effective October 19, 2022

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates for Select Medications - Effective October 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits - Effective October 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective October 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code - Effective October 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Tramadol/Celecoxib (Seglentis®) – Effective October 1, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Update: FDA Emergency Use Authorization for COVID-19 Bivalent Booster Vaccine - Effective August 31, 2022

Louisiana Medicaid Pharmacy Smallpox Monkeypox (Live) Vaccine (Jynneos®) Coverage - Effective September 15, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Update: FDA Emergency Use Authorization for Novavax COVID-19 Vaccine, Adjuvanted - Effective July 13, 2022

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective July 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits – Effective July 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Tramadol-Containing Products – Effective July 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates for Select Medications - Effective July 1, 2022

Louisiana Medicaid Pharmacy Palivizumab (Synagis®) Coverage for Off Season and Respiratory Syncytial Virus (RSV) Season - Effective July 1, 2022

Pharmacy Providers RxPA Information Letter - Effective July 1, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing: Administration Fee Update - Effective July 1, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Update: COVID-19 Vaccine Coverage for 3 to 4 years old - Effective June 20, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing Update: Addition of Booster Dose Ages 5-11- Effective May 17, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing Update: Requirements for Second Booster Dose - Effective March 29, 2022

Pharmacy Providers RxPA Information Letter - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates for Select Medications - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Dispensing Fees for Maintenance Medications - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Prior Use Requirement - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Edits for Lorazepam (Loreev XR™) - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective April 1, 2022

Louisiana Medicaid Pharmacy Single Preferred Drug List (PDL) Update for Epoetin Alfa (Epogen®) - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Therapeutic Duplication - Effective April 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirements - Effective April 1, 2022

Louisiana Medicaid Pharmacy Coverage Update: FDA Authorized OTC At Home COVID-19 Tests

Louisiana Medicaid Pharmacy Coverage: COVID-19 Oral Treatment Agents and At Home COVID-19 Tests

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing Update: New Requirements for Booster Shot and Third Dose - Effective January 18, 2022

Pharmacy Providers RxPA Information Letter - Effective January 1, 2022

Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code Requirement and Bypass Diagnosis Codes - Effective January 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Criteria Updates - Effective January 1, 2022

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - Effective January 1, 2022

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing Update: New Age Requirements for Booster Shot- Effective December 17, 2021

Louisiana Medicaid Pharmacy COVID-19 Vaccine Billing Update for Age Requirement, Third Dose and Booster Shot - Effective November 15, 2021

Louisiana Medicaid Pharmacy Criteria Update for Aducanumab-avwa (Aduhelm™) – Effective November 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Edits for HIV agents, Sacubitril/Valsartan (Entresto®), and Dapagliflozin (Farxiga®) - Effective October 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Criteria Updates - Effective October 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Quantity Limits for October 2021 - Effective October 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Edits for Viloxazine (Qelbree™) - Effective October 1, 2021

August 2021 Hurricane Ida Information for Medicaid Pharmacy - Effective August 28, 2021 - Revised September 3, 2021

Louisiana Medicaid Pharmacy COVID-19 Vaccine Coverage Updates - Effective September 1, 2021

Pharmacy Providers RxPA Information Letter - Effective August 10, 2021

Louisiana Medicaid Pharmacy Palivizumab (Synagis®) Coverage - Effective July 15, 2021

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

Louisiana Medicaid Pharmacy Point of Sale Quantity Limit for Dulaglutide (Trulicity®) - Effective July 1, 2021

Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Criteria Updates for Select Drugs - Effective July 1, 2021

Louisiana Medicaid Pharmacy Educational Alert for Opioid Prescriptions - Effective July 1, 2021

Louisiana Medicaid Pharmacy Pfizer COVID-19 Vaccine Coverage for 12 Years of Age and Older - Effective May 10, 2021

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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