Managed Care Pharmacy and Medical Drug Policies

In accordance with La. R.S. 46:460.51, et seq., prior to adopting, approving, amending, or implementing certain policies or procedures, LDH will publish the proposed policy or procedure for the purpose of soliciting public comments. For this purpose, a policy or procedure, as defined by the statute, 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.

The following table contains the LDH and managed care organization pharmacy and medical drug policies that are open for public comment. To provide feedback, please complete this form. Refer to the links below the table for archived postings and public comments.

Item Number	Policy/Procedure Date Posted Comment Period Closed Status	Date Posted	Comment Period Closed Status	Status	Document Links
2026-LHCC-MED-1013	Atezolizumab (Tecentriq)	6/4/26	7/19/26	Pending	Atezolizumab (Tecentriq)
2026-LHCC-MED-1012	Paclitaxel, Protein-Bound (Abraxane)	6/4/26	7/19/26	Pending	Paclitaxel, Protein-Bound (Abraxane)
2026-LHCC-MED-1011	Nivolumab (Opdivo)	6/4/26	7/19/26	Pending	Nivolumab (Opdivo)
2026-LHCC-MED-1010	Mitoxantrone	6/4/26	7/19/26	Pending	Mitoxantrone
2026-LHCC-MED-1009	Ado-Trastuzumab Emtansine (Kadcyla)	6/4/26	7/19/26	Pending	Ado-Trastuzumab Emtansine (Kadcyla)
2026-LHCC-MED-1008	Revakinagene taroretcel-lwey  (Encelto)	6/4/26	7/19/26	Pending	Revakinagene taroretcel-lwey  (Encelto)
2026-LHCC-MED-1007	Remestemcel-L-rknd (Ryoncil)	6/4/26	7/19/26	Pending	Remestemcel-L-rknd (Ryoncil)
2026-LHCC-MED-1006	Ciltacabtagene Autoleucel (Carvykti)	6/4/26	7/19/26	Pending	Ciltacabtagene Autoleucel (Carvykti)
2026-LHCC-MED-1005	Obinutuzumab (Gazyva)	6/4/26	7/19/26	Pending	Obinutuzumab (Gazyva)
2026-LHCC-MED-1004	Pegunigalsidase alfa-iwxj (Elfabrio)	6/4/26	7/19/26	Pending	Pegunigalsidase alfa-iwxj (Elfabrio)
2026-LHCC-MED-1003	Desmopressin Acetate (DDAVP)	6/4/26	7/19/26	Pending	Desmopressin Acetate (DDAVP)
2026-LHCC-MED-1002	Efgartigimod Alfa-fcab (Vyvgart)	6/4/26	7/19/26	Pending	Efgartigimod Alfa-fcab (Vyvgart)
2026-ACLA-MED-131	Somatostatin Analogs and Growth Hormone Receptor Antagonists	5/27/26	7/11/26	Pending	Somatostatin Analogs and Growth Hormone Receptor Antagonists
2026-ACLA-MED-132	Anti-CD19 CAR-T Immunotherapies	5/27/26	7/11/26	Pending	Anti-CD19 CAR-T Immunotherapies
2026-ACLA-MED-133	Loargys	5/27/26	7/11/26	Pending	Loargys
2026-LHCC-MED-993	Amivantamab-vmjw (Rybrevant)	5/7/26	6/21/26	Pending	Amivantamab-vmjw (Rybrevant)
2026-LHCC-MED-994	Ramucirumab (Cyramza)	5/7/26	6/21/26	Pending	Ramucirumab (Cyramza)
2026-LHCC-MED-995	Tremelimumab-actl (Imjudo)	5/7/26	6/21/26	Pending	Tremelimumab-actl (Imjudo)
2026-LHCC-MED-996	Fam-Trastuzumab Deruxtecan-nxki (Enhertu)	5/7/26	6/21/26	Pending	Fam-Trastuzumab Deruxtecan-nxki (Enhertu)
2026-LHCC-MED-997	Furosemide (Furoscix)	5/7/26	6/21/26	Pending	Furosemide (Furoscix)
2026-LHCC-MED-998	Letermovir (Prevymis)	5/7/26	6/21/26	Pending	Letermovir (Prevymis)
2026-LHCC-MED-999	Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela)	5/7/26	6/21/26	Pending	Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela)
2026-LHCC-MED-1000	Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo)	5/7/26	6/21/26	Pending	Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo)
2026-LHCC-MED-1001	Eculizumab (Soliris)	5/7/26	6/21/26	Pending	Eculizumab (Soliris)
2026-PHARM-38	Aqvesme	4/30/26	6/14/26	Pending	Aqvesme
2026-PHARM-39	Blujepa	4/30/26	6/14/26	Pending	Blujepa
2026-PHARM-40	Dermatology - Atopic Dermatitis, Immunomodulators	4/30/26	6/14/26	Pending	Dermatology - Atopic Dermatitis, Immunomodulators
2026-PHARM-41	Exdensur	4/30/26	6/14/26	Pending	Exdensur
2026-PHARM-42	Forzinity	4/30/26	6/14/26	Pending	Forzinity
2026-PHARM-43	Heart Disease - Hyperlipidemia, Lipotropics Other	4/30/26	6/14/26	Pending	Heart Disease - Hyperlipidemia, Lipotropics Other
2026-PHARM-44	Hereditary Angioedema	4/30/26	6/14/26	Pending	Hereditary Angioedema
2026-PHARM-45	Itvisma	4/30/26	6/14/26	Pending	Itvisma
2026-PHARM-46	Louisiana Medicaid ICD-10 Chart	4/30/26	6/14/26	Pending	Louisiana Medicaid ICD-10 Chart
2026-PHARM-47	Lynkuet	4/30/26	6/14/26	Pending	Lynkuet
2026-PHARM-48	Multivitamins	4/30/26	6/14/26	Pending	Multivitamins
2026-PHARM-49	Myqorzo	4/30/26	6/14/26	Pending	Myqorzo
2026-PHARM-50	Orlynvah	4/30/26	6/14/26	Pending	Orlynvah
2026-PHARM-51	Pain Management - Cytokine/CAM Antagonists	4/30/26	6/14/26	Pending	Pain Management - Cytokine/CAM Antagonists
2026-PHARM-52	Pain Management - Non-Steroidal AntiInflammatory Agents	4/30/26	6/14/26	Pending	Pain Management - Non-Steroidal AntiInflammatory Agents
2026-PHARM-53	Pain Management - Skeletal Muscle Relaxants	4/30/26	6/14/26	Pending	Pain Management - Skeletal Muscle Relaxants
2026-PHARM-54	Papzimeos	4/30/26	6/14/26	Pending	Papzimeos
2026-PHARM-55	Pediatric Multivitamins with Fluoride	4/30/26	6/14/26	Pending	Pediatric Multivitamins with Fluoride
2026-PHARM-56	POS ADD-ADHD Stimulants and Related Agents	4/30/26	6/14/26	Pending	POS ADD-ADHD Stimulants and Related Agents
2026-PHARM-57	POS Allergy - Antihistamines, Minimally Sedating	4/30/26	6/14/26	Pending	POS Allergy - Antihistamines, Minimally Sedating
2026-PHARM-58	POS Antipsychotic Agents, Oral/Transdermal	4/30/26	6/14/26	Pending	POS Antipsychotic Agents, Oral/Transdermal
2026-PHARM-59	POS Aqvesme	4/30/26	6/14/26	Pending	POS Aqvesme
2026-PHARM-60	POS Blujepa	4/30/26	6/14/26	Pending	POS Blujepa
2026-PHARM-61	POS Dermatology - Atopic Dermatitis, Immunomodulators	4/30/26	6/14/26	Pending	POS Dermatology - Atopic Dermatitis, Immunomodulators
2026-PHARM-62	POS Exdensur	4/30/26	6/14/26	Pending	POS Exdensur
2026-PHARM-63	POS Exxua	4/30/26	6/14/26	Pending	POS Exxua
2026-PHARM-64	POS Lynkuet	4/30/26	6/14/26	Pending	POS Lynkuet
2026-PHARM-65	POS Myqorzo	4/30/26	6/14/26	Pending	POS Myqorzo
2026-PHARM-66	POS Orlynvah	4/30/26	6/14/26	Pending	POS Orlynvah
2026-PHARM-67	POS Pain Management - Non-Steroidal AntiInflammatory Agents	4/30/26	6/14/26	Pending	POS Pain Management - Non-Steroidal AntiInflammatory Agents
2026-PHARM-68	POS Pain Management - Skeletal Muscle Relaxants	4/30/26	6/14/26	Pending	POS Pain Management - Skeletal Muscle Relaxants
2026-PHARM-69	POS Voyxact	4/30/26	6/14/26	Pending	POS Voyxact
2026-PHARM-70	POS Zepbound	4/30/26	6/14/26	Pending	POS Zepbound
2026-PHARM-71	Redemplo	4/30/26	6/14/26	Pending	Redemplo
2026-PHARM-72	Sedative/Hypnotics	4/30/26	6/14/26	Pending	Sedative/Hypnotics
2026-PHARM-73	Starjemza	4/30/26	6/14/26	Pending	Starjemza
2026-PHARM-74	Yartemlea	4/30/26	6/14/26	Pending	Yartemlea
2026-PHARM-75	Zycubo	4/30/26	6/14/26	Pending	Zycubo