LETTER TO PROVIDERS
July 14, 2003
Practitioners and Pharmacy Providers:
Attached is a
listing of drugs on the Medicaid Prior Authorization (PA) Process' Preferred
Drug List (PDL). The listing includes preferred drugs and those drugs requiring
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 "03-04".
Please be advised this attachment contains the current drug listings on the
PDL and supersedes all previous lists issued.
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.
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 is followed.
Also, attached is
Appendix D detailing the information required to review retroactive eligibility. Please be advised that pharmacy claims will only be overridden for the
prior authorization edit for eligibles
with certified retroactive eligibility. Claims submitted for eligibles who do not have retroactive eligibility
will not have the PA edit overridden.
Thank you for
your continued cooperation. We appreciate your participation in the Medicaid
Ben A. Bearden
The above letter and the Preferred Drug
also available in PDF format on the Downloadable
Forms and Files page.