On this page is a compilation of the obsolete pages as they correspond to the revision date. Click on a date to see the manual chapter page(s) prior to the revision.

Pages replaced from 12/23/2021 revision – Section 37.5.4 – Contact Information

Pages replaced from 08/12/2021 revision – Table of Contents

Pages replaced from 08/12/2021 revision – Section 37.0 – Overview

Pages replaced from 08/12/2021 revision – Section 37.2 – Provider Requirements

Pages replaced from 08/12/2021 revision – Section 37.3 – Reimbursement

Pages replaced from 08/12/2021 revision – Section 37.4 – Managed Care Applicability

Pages replaced from 08/12/2021 revision – Section 37.5.2 – Claims Related Information

Pages replaced from 08/12/2021 revision – Section 37.5.3 – Glossary

Pages replaced from 08/12/2021 revision – Section 37.5.6 – Prescribers

Pages replaced from 08/12/2021 revision – Section 37.5.7 – Medicare Prescription Drug Coverage

Pages replaced from 08/12/2021 revision – Section 37.5.8 – Claims Submission and Processing Payments

Pages replaced from 08/12/2021 revision – Section 37.5.10 – Total Parenteral Nutrition

Pages replaced from 08/12/2021 revision – Section 37.5.12 – Patient Counseling and Drug Utilization Review

Pages replaced from 08/12/2021 revision – Section 37.5.13 – Lock-In Program

Pages replaced from 08/05/2021 revision – Section 37.1 – Covered Services, Limitations and Exclusions

Pages replaced from 07/01/2021 revision – Section 37.1 – Covered Services, Limitations and Exclusions

Pages replaced from 07/01/2021 revision – Section 37.5.3 – Glossary and Acronyms

Pages replaced from 06/24/2021 revision – Section 37.5.11 – Medication Administration

Pages replaced from 05/28/2021 revision – Section 37.5.2 – Claims Related Information

Pages replaced from 04/26/2021 revision – Section 37.1 – Covered Services

Pages replaced from 01/05/2021 revision – Section 37.1 – Covered Services

Pages replaced from 11/06/2020 revision – Section 37.1 – Covered Services

Pages replaced from 05/27/2020 revision – Previous Pharmacy Manual Version

Pages replaced from 02/06/2020 revision – Section 37.1 – Covered Services

Pages replaced from 02/06/2020 revision – Section 37.3 – Reimbursement

Page replaced from 01/14/2020 revision – Title Page

Page replaced from 07/16/2019 revision – Section 37.3 - Reimbursement

Pages replaced from 07/01/2019 revision – Table of Contents

Page replaced from 07/01/2019 revision – Section 37.0 - Overview

Page replaced from 07/01/2019 revision – Section 37.1 – General Program Information

Page replaced from 07/01/2019 revision – Section 37.3 – Medicaid Recipient Eligibility

Pages replaced from 07/01/2019 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Pages replaced from 07/01/2019 revision – Section 37.6 – Reimbursement for Pharmacy Services

Page replaced from 07/01/2019 revision – Appendix A Drugs Payable on Drug File

Page replaced from 07/01/2019 revision – Appendix A-1 List of Drugs with Average Acquisition Rates

Page replaced from 07/01/2019 revision – Appendix B DESI Drugs by National Drug Code (NDC)

Page replaced from 07/01/2019 revision – Appendix C Medicaid Drug Federal Rebate Participation Pharmaceutical Companies

Pages replaced from 07/01/2019 revision – Appendix D Point of Sale User Guide

Page replaced from 07/01/2019 revision – Appendix E-1 Products with Quantity Limits

Page replaced from 07/01/2019 revision – Appendix E-2 Products with Maximum Daily Dosages

Page replaced from 07/01/2019 revision – Appendix F Forms

Page replaced from 07/01/2019 revision – Appendix G Universal Claim Form and Instruction

Page replaced from 07/01/2019 revision – Appendix H Form 211 – Drug Adjustment/Void

Page replaced from 07/01/2019 revision – Appendix I PA01 Form – TPN Prior Authorization

Pages replaced from 07/01/2019 revision – Appendix J Claims Filing

Page replaced from 07/01/2019 revision – Appendix K Reserved

Page replaced from 07/01/2019 revision – Appendix L Tamper Resistant Prescription Criteria and Examples

Pages replaced from 07/01/2019 revisions – Appendix M Glossary and Acronyms

Pages replaced from 07/01/2019 revision – Appendix N Contact Information

Page replaced from 07/01/2019 revision – Appendix O Louisiana Medicaid Single Preferred Drug List (PDL) Prior Authorization List

Page replaced from 07/01/2019 revision – Appendix P Diagnosis Code Chart

Page replaced from 05/03/2019 revision – Appendix O – Preferred Drug List/Prior Authorization

Page replaced from 05/01/2019 revision – Appendix O – Preferred Drug List/Prior Authorization

Pages replaced from 09/25/2018 revision – Table of Contents

Pages replaced from 09/25/2018 revision – Section 37.5 – Covered Services, Limitations, and Exclusions

Pages replaced from 09/25/2018 revisions - Appendix F – Forms

Page replaced from 09/25/2018 revision – Appendix N – Contact Information

Pages replaced from 07/19/2018 revision – Section 37.5 – Covered Services, Limitations, and Exclusions

Pages replaced from 06/15/2018 revision - Section 37.2 Pharmacy Provider Enrollment and Participation Guidelines

Pages replaced from 06/15/2018 revision - Section 37.5: Covered Services, Limitations and Exclusions

Pages replaced from 05/07/2018 revision – Section 37.5 – Covered Services, Limitations, and Exclusions

Pages replaced from 03/29/2018 revision – Table of Contents

Pages replaced from 03/29/2018 revision – Section 37.5 – Covered Services, Limitations, and Exclusions

Pages replaced from 10/13/2017 revision – Table of Contents

Pages replaced from 10/13/12017 revision – Section 37.5 – Covered Services, Limitations, and Exclusions

Pages replaced from 10/13/2017 revision – Section 37.11 – Public Health Services 340B Drug Pricing Program

Pages replaced from 10/13/2017 revision – Appendix F: Forms

Pages replaced from 08/01/2017 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Page replaced from 08/01/2017 revision – Appendix C Medicaid Drug Federal Rebate Participation Pharmaceutical Companies

Pages replaced from 04/27/2017 revision – Section 37.5 – Covered Services, Limitations and Exclusion

Pages replaced from 03/15/2017 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Page replaced from 01/20/2017 revision – Appendix E-1 Products with Quantity Limits

Pages replaced from 01/10/2017 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Pages replaced from 11/17/2016 revision – Table of Contents

Pages replaced from 11/17/2016 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Page replaced from 09/27/2016 revision – Appendix A-1 List of Drugs with Average Acquisition Rates

Page replaced from 09/27/2016 revision – Title Page

Pages replaced from 09/27/2016 revision – Table of Contents

Page replaced from 09/27/2016 revision – Overview

Page replaced from 09/27/2016 revision – Section 37.1 – General Program Information

Pages replaced from 09/27/2016 revision – Section 37.2 – Pharmacy Provider Enrollment and Participation Guidelines

Page replaced from 09/27/2016 revision – Section 37.3 – Medicaid Recipient Eligibility

Pages replaced from 09/27/2016 revision – Section 37.4 – Prescribers

Pages replaced from 09/27/2016 revision – Section 37.5 – Covered Services, Limitations and Exclusions

Pages replaced from 09/27/2016 revision – Section 37.6 – Reimbursement for Pharmacy Services

Pages replaced from 09/27/2016 revision – Section 37.7 – Medicare Prescription Drug Coverage

Pages replaced from 09/27/2016 revision – Section 37.8 – Third Party Liability/Coordination of Benefits

Pages replaced from 09/27/2016 revision – Section 37.9 – Claim Submission

Pages replaced from 09/27/2016 revision – Section 37.10 – Claims Processing/Payments

Pages replaced from 09/27/2016 revision – Section 37.11 – Public Health Services 340B Drug Pricing Program

Pages replaced from 09/27/2016 revision – Section 37.12 – Total Parenteral Nutrition

Page replaced from 09/27/2016 revision – Section 37.13 – Reserved

Pages replaced from 09/27/2016 revision – Section 37.14 – Medication Administration

Pages replaced from 09/27/2016 revision – Section 37.16 – Patient Counseling and Drug Utilization Review (DUR)

Pages replaced from 09/27/2016 revision – Section 37.17 – Lock-In Program

Page replaced from 09/27/2016 revision – Section 37.18 – Reserved

Pages replaced from 09/27/2016 revision – Section 37.19 – Medicaid Fraud and Abuse

Pages replaced from 09/27/2016 revision – Section 37.20 – Provider Audits

Pages replaced from 09/27/2016 revision – Section 37.21 – Medicaid Drug Rebate Program

Pages replaced from 09/27/2016 revision – Section 37.22 – Louisiana Medicaid Website

Pages replaced from 09/27/2016 revision - Glossary

Pages replaced from 09/27/2016 revision - Acronyms

Pages replaced from 09/27/2016 revision - Frequent Contact Information

Page replaced from 09/27/2016 revision – Appendix A Drugs Payable on Drug File

Page replaced from 09/27/2016 revision – Appendix A-1 List of Drugs with Average Acquisition Rates

Page replaced from 09/27/2016 revision – Appendix B DESI Drugs by National Drug Code (NDC)

Page replaced from 09/27/2016 revision – Appendix C Medicaid Drug Federal Rebate Participation Pharmaceutical Companies

Page replaced from 09/27/2016 revision – Appendix E-1 Products with Quantity Limits

Page replaced from 09/27/2016 revision – Appendix E-2 Products with Maximum Daily Dosages

Page replaced from 09/27/2016 revision – Appendix F Forms

Page replaced from 09/27/2016 revision – Appendix G Universal Claim Form and Instruction

Page replaced from 09/27/2016 revision – Appendix H Form 211 – Drug Adjustment/Void

Page replaced from 09/27/2016 revision – Appendix I PA01 Form – TPN Prior Authorization

Pages replaced from 09/27/2016 revision – Appendix J Claims Filing

Page replaced from 09/27/2016 revision – Appendix K Reserved

Page replaced from 09/27/2016 revision – Appendix L Tamper Resistant Prescription Criteria and Examples

Page replaced from 09/25/2015 revision – Title Page

Obsolete Pharmacy Section 37.5 Covered Services, Limitations, and Exclusions (issue date 04/01/11)

Obsolete Pharmacy Benefits Management Services, Chapter 37 (issue date 01/01/12)

Obsolete Appendix A (issue date 08/15/07)

Obsolete Appendix A-1 (issue date 02/19/10)

Obsolete Appendix B (issue date 08/15/07)

Obsolete Appendix C (issue date 08/15/07)

Obsolete Appendix D (issue date 08/15/07)

Obsolete Appendix E-1 (issue date 04/01/11)

Obsolete Appendix E-2 (issue date 04/01/11)

Obsolete Appendix G (issue date 12/01/05)

Obsolete Appendix H (issue date 08/15/07)

Obsolete Appendix I (issue date 08/15/07)

Obsolete Appendix J (issue date 08/15/07)

Obsolete Appendix K (issue date 11/01/08)

Obsolete Appendix L (issue date 11/01/08)

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