LETTER TO PRESCRIBING PRACTITIONERS
September 20, 2007
Dear Prescribing 
Practitioner:
RE:  PDL # 07-02
Attached is the 
complete, most current listing of drugs on the Medicaid Prior Authorization (PA) 
Process' Preferred Drug List (PDL) "07-02."  The listing includes 
preferred drugs and those drugs requiring prior authorization.  This list 
will be effective October 1, 2007.  
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)."
This issuance of the PDL includes the COX-2 
selective agent, Celebrex®. Please be reminded that several years ago, the FDA 
issued a Public Health Advisory, which stated that use of a COX-2 selective 
agent may be associated with an increased risk of serious cardiovascular events, 
especially when they are used for long periods of time or in very high-risk 
settings.
As a result of this Public Health Advisory 
and to help ensure the safety and well being of Medicaid patients, our current 
policy requires the prescribing practitioner to include:
	- The condition being treated with the COX-2 selective 
	agent by indicating the ICD-9-CM diagnosis code of the treated condition 
	(e.g. Osteoarthritis - 715.0) on all new prescriptions written for a COX-2 
	selective agent; and
- The reason a COX-2 selective agent is used rather than 
	a non-selective NSAID (e.g. treatment failure or history of a GI bleed).
The ICD-9-CM diagnosis code and the 
rationale for the choice of a COX-2 must be noted in the prescriber's 
handwriting. A rubber stamp notation is not acceptable.
A prescription written for a COX-2 selective 
agent that includes a diagnosis code without a rationale for using the COX-2 
selective agent will be set to process without an override when the following 
criteria is met:
	- Patient has current prescription for H2 receptor 
	antagonists;
- Patient has current prescription for proton pump 
	inhibitor;
- Patient has current prescription for warfarin;
- Patient has current prescriptions indicating chronic 
	use of oral steroids; or
- Patient is sixty years old or greater.
The goal is to 
assure appropriate use of this COX-2 selective agent and allow pharmacy claims 
to process when gastrointestinal risks appear likely with use of the 
non-selective NSAIDs.
Information on 
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.   
Thank you for 
your continued cooperation. We appreciate your participation in the Medicaid 
Program.
Sincerely, 
 
Jerry Phillips
Medicaid Director
MJT/alp
Attachments (2)
The above letter and the Preferred Drug
List are
also available in PDF format on the Downloadable
Forms and Files page.