Medicaid Managed Care Policies & Procedures Archive - Pharmacy (2026)

"Policy or procedure" shall mean a requirement governing the administration of managed care organizations specific to billing guidelines, medical management and utilization review guidelines, case management guidelines, claims processing guidelines and edits, grievance and appeals procedures and process, other guidelines or manuals containing pertinent information related to operations and pre-processing claims, and core benefits and services.

Below are items previously posted for public comment:

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Item Number	Policy/Procedure	Date Posted	Comment Period Closed	Status	Document Links
2026-ACLA-MED-129	Papzimeos	2/27/26	4/13/26	Complete	Papzimeos
2026-LHCC-MED-904	Valrubicin (Valstar)	2/9/26	3/26/26	Complete	Valrubicin (Valstar)
2026-LHCC-MED-905	Tafasitamab-cxix (Monjuvi)	2/9/26	3/26/26	Complete	Tafasitamab-cxix (Monjuvi)
2026-LHCC-MED-906	Irinotecan Liposome (Onivyde)	2/9/26	3/26/26	Complete	Irinotecan Liposome (Onivyde)
2026-LHCC-MED-907	Levoleucovorin (Fusilev, Khapzory)	2/9/26	3/26/26	Complete	Levoleucovorin (Fusilev, Khapzory)
2026-LHCC-MED-908	Eribulin Mesylate (Halaven)	2/9/26	3/26/26	Complete	Eribulin Mesylate (Halaven)
2026-LHCC-MED-909	Daunorubicin/Cytarabine (Vyxeos)	2/9/26	3/26/26	Complete	Daunorubicin/Cytarabine (Vyxeos)
2026-LHCC-MED-910	Leucovorin Injection	2/9/26	3/26/26	Complete	Leucovorin Injection
2026-LHCC-MED-911	Tofersen (Qalsody)	2/9/26	3/26/26	Complete	Tofersen (Qalsody)
2026-LHCC-MED-912	Obinutuzumab (Gazyva)	2/9/26	3/26/26	Complete	Obinutuzumab (Gazyva)
2026-LHCC-MED-913	Pralatrexate (Folotyn)	2/9/26	3/26/26	Complete	Pralatrexate (Folotyn)
2026-LHCC-MED-914	Antithymocyte Globulin (Atgam, Thymoglobulin)	2/9/26	3/26/26	Complete	Antithymocyte Globulin (Atgam, Thymoglobulin)
2026-LHCC-MED-915	Inotuzumab Ozogamicin (Besponsa)	2/9/26	3/26/26	Complete	Inotuzumab Ozogamicin (Besponsa)
2026-LHCC-MED-916	Tisotumab Vedotin-tftv (Tivdak)	2/9/26	3/26/26	Complete	Tisotumab Vedotin-tftv (Tivdak)
2026-LHCC-MED-917	Ofatumumab (Arzerra)	2/9/26	3/26/26	Complete	Ofatumumab (Arzerra)
2026-LHCC-MED-886	Avacincaptad pegol (Izervay)	2/9/26	3/26/26	Complete	Avacincaptad pegol (Izervay)
2026-LHCC-MED-887	Asfotase Alfa (Strensiq)	2/9/26	3/26/26	Complete	Asfotase Alfa (Strensiq)
2026-LHCC-MED-888	Azacitidine (Onureg, Vidaza)	2/9/26	3/26/26	Complete	Azacitidine (Onureg, Vidaza)
2026-LHCC-MED-889	Ravulizumab-cwvz (Ultomiris)	2/9/26	3/26/26	Complete	Ravulizumab-cwvz (Ultomiris)
2026-LHCC-MED-890	Cetuximab (Erbitux)	2/9/26	3/26/26	Complete	Cetuximab (Erbitux)
2026-LHCC-MED-891	Carfilzomib (Kyprolis)	2/9/26	3/26/26	Complete	Carfilzomib (Kyprolis)
2026-LHCC-MED-892	Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta)	2/9/26	3/26/26	Complete	Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta)
2026-LHCC-MED-893	Rozanolixizumab-noli (Rystiggo)	2/9/26	3/26/26	Complete	Rozanolixizumab-noli (Rystiggo)
2026-LHCC-MED-894	Talquetamab-tgvs (Talvey)	2/9/26	3/26/26	Complete	Talquetamab-tgvs (Talvey)
2026-LHCC-MED-895	Elranatamab-bcmm (Elrexfio)	2/9/26	3/26/26	Complete	Elranatamab-bcmm (Elrexfio)
2026-LHCC-MED-896	Melphalan (Hepzato)	2/9/26	3/26/26	Complete	Melphalan (Hepzato)
2026-LHCC-MED-873	Mogamulizumab-kpkc (Poteligeo)	2/9/26	3/26/26	Complete	Mogamulizumab-kpkc (Poteligeo)
2026-LHCC-MED-874	Pasireotide (Signifor, Signifor LAR)	2/9/26	3/26/26	Complete	Pasireotide (Signifor, Signifor LAR)
2026-LHCC-MED-875	Pegvisomant (Somavert)	2/9/26	3/26/26	Complete	Pegvisomant (Somavert)
2026-LHCC-MED-876	Lanreotide (Somatuline Depot)	2/9/26	3/26/26	Complete	Lanreotide (Somatuline Depot)
2026-LHCC-MED-877	Belatacept (Nulojix)	2/9/26	3/26/26	Complete	Belatacept (Nulojix)
2026-LHCC-MED-878	Necitumumab (Portrazza)	2/9/26	3/26/26	Complete	Necitumumab (Portrazza)
2026-LHCC-MED-879	Ziv-aflibercept (Zaltrap)	2/9/26	3/26/26	Complete	Ziv-aflibercept (Zaltrap)
2026-LHCC-MED-880	Plasminogen, Human-tvmh (Ryplazim)	2/9/26	3/26/26	Complete	Plasminogen, Human-tvmh (Ryplazim)
2026-LHCC-MED-881	Belinostat (Beleodaq)	2/9/26	3/26/26	Complete	Belinostat (Beleodaq)
2026-LHCC-MED-882	Romidepsin (Istodax)	2/9/26	3/26/26	Complete	Romidepsin (Istodax)
2026-LHCC-MED-883	Temsirolimus (Torisel)	2/9/26	3/26/26	Complete	Temsirolimus (Torisel)
2026-LHCC-MED-884	Pegaspargase (Oncaspar), Calaspargase Pegol-mknl	2/9/26	3/26/26	Complete	Pegaspargase (Oncaspar), Calaspargase Pegol-mknl
2026-LHCC-MED-885	Denileukin Diftitox-cxdl (Lymphir)	2/9/26	3/26/26	Complete	Denileukin Diftitox-cxdl (Lymphir)
2026-LHCC-MED-872	Zopapogene Imadenovec (Papzimeos)	2/6/26	3/23/26	Complete	Zopapogene Imadenovec (Papzimeos)
2026-LHCC-MED-897	Brexucabtagene Autoleucel (Tecartus)	2/6/26	3/23/26	Complete	Brexucabtagene Autoleucel (Tecartus)
2026-LHCC-MED-898	Talimogene laherepvec (Imlygic)	2/6/26	3/23/26	Complete	Talimogene laherepvec (Imlygic)
2026-LHCC-MED-899	Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase	2/6/26	3/23/26	Complete	Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase
2026-LHCC-MED-900	Atezolizumab (Tecentriq)	2/6/26	3/23/26	Complete	Atezolizumab (Tecentriq)
2026-LHCC-MED-901	Pemetrexed (Alimta, Pemfexy)	2/6/26	3/23/26	Complete	Pemetrexed (Alimta, Pemfexy)
2026-LHCC-MED-902	Cemiplimab-rwlc (Libtayo)	2/6/26	3/23/26	Complete	Cemiplimab-rwlc (Libtayo)
2026-LHCC-MED-903	Motixafortide (Aphexda)	2/6/26	3/23/26	Complete	Motixafortide (Aphexda)
2026-ACLA-MED-128	VEGF Inhibitors	2/6/26	3/23/26	Complete	VEGF Inhibitors
2026-PHARM-6	Asthma/COPD - Immunomodulators	2/6/26	3/23/26	Complete	Asthma/COPD - Immunomodulators
2026-PHARM-7	Avtozma	2/6/26	3/23/26	Complete	Avtozma
2026-PHARM-8	Brinsupri	2/6/26	3/23/26	Complete	Brinsupri
2026-PHARM-9	Casgevy	2/6/26	3/23/26	Complete	Casgevy
2026-PHARM-10	Dawnzera	2/6/26	3/23/26	Complete	Dawnzera
2026-PHARM-11	Ekterly	2/6/26	3/23/26	Complete	Ekterly
2026-PHARM-12	Exxua	2/6/26	3/23/26	Complete	Exxua
2026-PHARM-13	Heart Disease - Hyperlipidemia, Lipotropics Other	2/6/26	3/23/26	Complete	Heart Disease - Hyperlipidemia, Lipotropics Other
2026-PHARM-14	Jascayd	2/6/26	3/23/26	Complete	Jascayd
2026-PHARM-15	Louisiana Medicaid ICD-10 Chart	2/6/26	3/23/26	Complete	Louisiana Medicaid ICD-10 Chart
2026-PHARM-16	Nypozi	2/6/26	3/23/26	Complete	Nypozi
2026-PHARM-17	Oncology Agents - Oral Other	2/6/26	3/23/26	Complete	Oncology Agents - Oral Other
2026-PHARM-18	Pain Management - Antimigraine Agents, CGRP Antagonists	2/6/26	3/23/26	Complete	Pain Management - Antimigraine Agents, CGRP Antagonists
2026-PHARM-19	Pain Management - Cytokine/CAM Antagonists	2/6/26	3/23/26	Complete	Pain Management - Cytokine/CAM Antagonists
2026-PHARM-20	Pain Management - Skeletal Muscle Relaxants	2/6/26	3/23/26	Complete	Pain Management - Skeletal Muscle Relaxants
2026-PHARM-21	POS Anzupgo	2/6/26	3/23/26	Complete	POS Anzupgo
2026-PHARM-22	POS Asthma/COPD - Immunomodulators	2/6/26	3/23/26	Complete	POS Asthma/COPD - Immunomodulators
2026-PHARM-23	POS Brinsupri	2/6/26	3/23/26	Complete	POS Brinsupri
2026-PHARM-24	POS Dermatology - Antipsoriatics, Topical	2/6/26	3/23/26	Complete	POS Dermatology - Antipsoriatics, Topical
2026-PHARM-25	POS Empaveli	2/6/26	3/23/26	Complete	POS Empaveli
2026-PHARM-26	POS Exxua	2/6/26	3/23/26	Complete	POS Exxua
2026-PHARM-27	POS Heart Disease - Hyperlipidemia, Anticoagulants	2/6/26	3/23/26	Complete	POS Heart Disease - Hyperlipidemia, Anticoagulants
2026-PHARM-28	POS Jascayd	2/6/26	3/23/26	Complete	POS Jascayd
2026-PHARM-29	POS Kirsty	2/6/26	3/23/26	Complete	POS Kirsty
2026-PHARM-30	POS Oncology - Oral Other	2/6/26	3/23/26	Complete	POS Oncology - Oral Other
2026-PHARM-31	POS Pain Management - Skeletal Muscle Relaxants	2/6/26	3/23/26	Complete	POS Pain Management - Skeletal Muscle Relaxants
2026-PHARM-32	POS Rhapsido	2/6/26	3/23/26	Complete	POS Rhapsido
2026-PHARM-33	POS Zurnai	2/6/26	3/23/26	Complete	POS Zurnai
2026-PHARM-34	Rhapsido	2/6/26	3/23/26	Complete	Rhapsido
2026-PHARM-35	Sephience	2/6/26	3/23/26	Complete	Sephience
2026-PHARM-36	Tyruko	2/6/26	3/23/26	Complete	Tyruko
2026-PHARM-37	Vyjuvek	2/6/26	3/23/26	Complete	Vyjuvek
2026-PHARM-5	Max Dose Override Buprenorphine	2/2/26	3/19/26	Complete	Max Dose Override Buprenorphine
2026-PHARM-1	Wegovy	1/16/26	3/2/26	Complete	Wegovy
2026-PHARM-2	POS Wegovy	1/16/26	3/2/26	Complete	POS Wegovy
2026-PHARM-3	Max Dose Override Buprenorphine	1/16/26	3/2/26	Complete	Max Dose Override Buprenorphine
2026-PHARM-4	POS Opiate Dependence Agents	1/16/26	3/2/26	Complete	POS Opiate Dependence Agents
2026-HB-MED-647	Rebyota (fecal microbiota, live – jslm)	1/7/26	2/21/26	Complete	Rebyota (fecal microbiota, live – jslm)
2026-HB-MED-648	Zinplava (bezlotoxumab)	1/7/26	2/21/26	Complete	Zinplava (bezlotoxumab)
2026-HB-MED-649	Xiaflex (collagenase clostridium histolyticum)	1/7/26	2/21/26	Complete	Xiaflex (collagenase clostridium histolyticum)
2026-HB-MED-650	Crysvita (burosumab-twza)	1/7/26	2/21/26	Complete	Crysvita (burosumab-twza)
2026-HB-MED-651	Veopoz (pozelimab-bbfg)	1/7/26	2/21/26	Complete	Veopoz (pozelimab-bbfg)
2026-HB-MED-652	Nexobrid (anacaulase-bcdb)	1/7/26	2/21/26	Complete	Nexobrid (anacaulase-bcdb)
2026-HB-MED-653	Gamifant (emapalumab-lzsg)	1/7/26	2/21/26	Complete	Gamifant (emapalumab-lzsg)
2026-HB-MED-654	Prostacyclin Infusion and Inhalation Therapy	1/7/26	2/21/26	Complete	Prostacyclin Infusion and Inhalation Therapy
2026-HB-MED-655	Scenesse (afamelanotide)	1/7/26	2/21/26	Complete	Scenesse (afamelanotide)