Prior Authorization (PA)
The Pharmacy Prior Authorization Program is a prescriber initiated request for prior
approval on a selected number of drugs (non-preferred) within specific therapeutic classes.
This request is made to the RxPA operational desk of the University of Louisiana at
Monroe (ULM) College of Pharmacy.
Appendix D. Retroactive Eligibility Process
Pharmacy Preferred Drug List (PDL) Archives
RxPA Archived Letters
Louisiana Medicaid Single Preferred Drug List
LA Uniform Prescription Drug Prior Authorization Form and Fax Coversheet
Palivizumab Clinical Authorization Form and Fax Coversheet