LETTER TO PROVIDERS
Attached is the
complete, most current listing of drugs on the Medicaid Prior Authorization (PA)
Process' Preferred Drug List (PDL) "05-01." The listing includes preferred drugs and those drugs requiring prior
list will be effective July 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.
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
should a claim deny because a PA is required, you may want to 1) verify that the
PA was actually obtained and the dates of service for the PA; 2) verify that the
filling date on the claim is subsequent to the start date of the PA. (Remember: PAs are not
retroactive); and 3) call the POS help desk at 1-800-648-0790 for further
In regards to the PDL/PA and Over The Counter (OTC)
drugs, Loratadine is the ONLY OTC item covered on the PDL effective July
1, 2005. Medicaid covers a limited
number of OTC products when a prescription is prescribed by the prescribing
practitioner. Medicaid also
requires the pharmacist bill using the NDC which is dispensed. OTC items should not be billed with the NDC for the legend
In an effort to
improve the efficiency of the retroactive prior authorization process, the
Louisiana Medicaid Pharmacy Benefits Management Section has implemented an
electronic method for submitting claims which need retroactive prior
authorization. Previously, pharmacy
providers were required to submit these claims on paper directly to Medicaid for
manual determination of retroactive eligibility and overrides.
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.