PHARMACY PRIOR AUTHORIZATION PROGRAM

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

RxPA Instructions

RxPA-Organizational-Structure

Contact Information


Louisiana Medicaid Single Preferred Drug List (PDL)

Louisiana Medicaid Single Preferred Drug List


Forms

LA Uniform Prescription Drug Prior Authorization Form and Fax Coversheet

Palivizumab Clinical Authorization Form and Fax Coversheet