LETTER TO PROVIDERS
Dear Prescribing Practitioners and Pharmacy
Attached is a listing of drugs to be added to the
Medicaid Prior Authorization (PA) Process' Preferred Drug List (PDL). The
listing includes preferred drugs and those drugs requiring prior authorization
with effective implementation dates shown. Please add this list to the
ones previously sent.
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 Medicaid PBM Program utilizes a numbering
system to assist providers in maintaining the lists disseminated. You will
note the list included with this correspondence is "03-02."
Please be advised this attachment contains updates to the previously issued
Prior Authorization PDL Implementation Schedules issued July 16, 2002 (Issuance
02-02), October 1, 2002 (Issuance 02-03), and February 4, 2003 (Issuance 03-01). These updates are noted on
the attachment in bold and include the following therapeutic classes:
Statins, Triptans, and Macrolides. Some drugs in these therapeutic classes
which previously required prior authorization have been moved to the PDL and
some drugs in these therapeutic classes which previously were on the PDL now
require prior authorization.
The effective dates of these changes are also shown on the chart. It is
recommended that you make notations with effective dates on transmittals
whenever changes occur in therapeutic classes to ensure you are referencing the
most current status of drug.
Information on the Prior Authorization process,
including the PDL and Prior Authorization Request Form (copy is attached, Form
RXPA), 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 provider of PDL changes that must be implemented in short time
The Department 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 if followed.
Thank you for your continued cooperation. We appreciate your participation in the Medicaid program.
Ben A. Bearden
The above letter and the Preferred Drug
also available in PDF format on the Downloadable
Forms and Files page.