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| Item Number | Policy/Procedure | Date Posted | Comment Period Closed | Status | Document Links |
|---|---|---|---|---|---|
| 2025-HB-MED-488 | Alyglo, Simlandi, Winrevair | 4/21/25 | 6/5/25 | Pending | Alyglo, Simlandi, Winrevair |
| 2025-HB-MED-521 | Givlaari | 4/17/25 | 6/1/25 | Pending | Givlaari |
| 2025-HB-MED-522 | Anktiva, Hercessi, Imdelltra | 4/17/25 | 6/1/25 | Pending | Anktiva, Hercessi, Imdelltra |
| 2025-UHC-MED-243 | Oncology Medication Clinical Coverage | 4/17/25 | 6/1/25 | Pending | Oncology Medication Clinical Coverage |
| 2025-UHC-MED-239 | Qalsody | 4/14/25 | 5/29/25 | Pending | Qalsody |
| 2025-UHC-MED-240 | Reblozyl | 4/14/25 | 5/29/25 | Pending | Reblozyl |
| 2025-UHC-MED-241 | Veopoz | 4/14/25 | 5/29/25 | Pending | Veopoz |
| 2025-LHCC-MED-777 | Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda) | 4/2/25 | 5/17/25 | Pending | Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda) |
| 2025-LHCC-MED-778 | Letermovir (Prevymis) | 4/2/25 | 5/17/25 | Pending | Letermovir (Prevymis) |
| 2025-LHCC-MED-779 | Cosyntropin (Cortrosyn) | 4/2/25 | 5/17/25 | Pending | Cosyntropin (Cortrosyn) |
| 2025-LHCC-MED-780 | Alglucosidase Alfa (Lumizyme) | 4/2/25 | 5/17/25 | Pending | Alglucosidase Alfa (Lumizyme) |
| 2025-LHCC-MED-781 | Triamcinolone ER Injection (Zilretta) | 4/2/25 | 5/17/25 | Pending | Triamcinolone ER Injection (Zilretta) |
| 2025-LHCC-MED-782 | Verteporfin (Visudyne) | 4/2/25 | 5/17/25 | Pending | Verteporfin (Visudyne) |
| 2025-LHCC-MED-783 | Trabectedin (Yondelis) | 4/2/25 | 5/17/25 | Pending | Trabectedin (Yondelis) |
| 2025-LHCC-MED-784 | Epoprostenol (Flolan, Veletri) | 4/2/25 | 5/17/25 | Pending | Epoprostenol (Flolan, Veletri) |
| 2025-LHCC-MED-785 | Tarlatamab-dlle (Imdelltra) | 4/2/25 | 5/17/25 | Pending | Tarlatamab-dlle (Imdelltra) |
| 2025-LHCC-MED-786 | Imetelstat (Rytelo) | 4/2/25 | 5/17/25 | Pending | Imetelstat (Rytelo) |
| 2025-LHCC-MED-787 | Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa) | 4/2/25 | 5/17/25 | Pending | Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa) |
| 2025-LHCC-MED-788 | Tislelizumab-jsgr (Tevimbra) | 4/2/25 | 5/17/25 | Pending | Tislelizumab-jsgr (Tevimbra) |
| 2025-LHCC-MED-789 | Immunization Coverage | 4/2/25 | 5/17/25 | Pending | Immunization Coverage |
| 2025-LHCC-MED-771 | Elotuzumab (Empliciti) | 4/2/25 | 5/17/25 | Pending | Elotuzumab (Empliciti) |
| 2025-LHCC-MED-772 | Ramucirumab (Cyramza) | 4/2/25 | 5/17/25 | Pending | Ramucirumab (Cyramza) |
| 2025-LHCC-MED-773 | Avelumab (Bavencio) | 4/2/25 | 5/17/25 | Pending | Avelumab (Bavencio) |
| 2025-LHCC-MED-774 | Bortezomib (Velcade) | 4/2/25 | 5/17/25 | Pending | Bortezomib (Velcade) |
| 2025-LHCC-MED-775 | Tisagenlecleucel (Kymriah) | 4/2/25 | 5/17/25 | Pending | Tisagenlecleucel (Kymriah) |
| 2025-LHCC-MED-776 | Axicabtagene ciloleucel (Yescarta) | 4/2/25 | 5/17/25 | Pending | Axicabtagene ciloleucel (Yescarta) |
| 2025-LHCC-MED-760 | Bezlotoxumab (Zinplava) | 4/2/25 | 5/17/25 | Pending | Bezlotoxumab (Zinplava) |
| 2025-LHCC-MED-761 | Allogenic Processed Thymus Tissue-agdc (Rethymic) | 4/2/25 | 5/17/25 | Pending | Allogenic Processed Thymus Tissue-agdc (Rethymic) |
| 2025-LHCC-MED-762 | Enfortumab Vedotin-ejfv (Padcev) | 4/2/25 | 5/17/25 | Pending | Enfortumab Vedotin-ejfv (Padcev) |
| 2025-LHCC-MED-763 | Protein C Concentrate, Human (Ceprotin) | 4/2/25 | 5/17/25 | Pending | Protein C Concentrate, Human (Ceprotin) |
| 2025-LHCC-MED-764 | Ibandronate Injection (Boniva) | 4/2/25 | 5/17/25 | Pending | Ibandronate Injection (Boniva) |
| 2025-LHCC-MED-765 | Voretigene Neparvovec-rzyl (Luxturna) | 4/2/25 | 5/17/25 | Pending | Voretigene Neparvovec-rzyl (Luxturna) |
| 2025-LHCC-MED-766 | Emapalumab-lzsg (Gamifant) | 4/2/25 | 5/17/25 | Pending | Emapalumab-lzsg (Gamifant) |
| 2025-LHCC-MED-767 | Teprotumumab (Tepezza) | 4/2/25 | 5/17/25 | Pending | Teprotumumab (Tepezza) |
| 2025-LHCC-MED-768 | Treprostinil (Remodulin) | 4/2/25 | 5/17/25 | Pending | Treprostinil (Remodulin) |
| 2025-LHCC-MED-769 | Sodium thiosulfate (Pedmark) | 4/2/25 | 5/17/25 | Pending | Sodium thiosulfate (Pedmark) |
| 2025-LHCC-MED-770 | Erwinia Asparaginase (Erwinaze, Rylaze) | 4/2/25 | 5/17/25 | Pending | Erwinia Asparaginase (Erwinaze, Rylaze) |
| 2025-LHCC-MED-756 | Obecabtagene autoleucel (Aucatzyl) | 4/2/25 | 5/17/25 | Pending | Obecabtagene autoleucel (Aucatzyl) |
| 2025-LHCC-MED-757 | Cosibelimab-Ipdl (Unloxcyt) | 4/2/25 | 5/17/25 | Pending | Cosibelimab-Ipdl (Unloxcyt) |
| 2025-LHCC-MED-758 | Zenocutuzumab-zbco (Bizengri) | 4/2/25 | 5/17/25 | Pending | Zenocutuzumab-zbco (Bizengri) |
| 2025-LHCC-MED-759 | Eladocagene Exuparvovec-tneq (Kebilidi) | 4/2/25 | 5/17/25 | Pending | Eladocagene Exuparvovec-tneq (Kebilidi) |
| 2025-LHCC-MED-731 | Agalsidase Beta (Fabrazyme) | 3/26/25 | 5/10/25 | Pending | Agalsidase Beta (Fabrazyme) |
| 2025-LHCC-MED-732 | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) | 3/26/25 | 5/10/25 | Pending | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) |
| 2025-LHCC-MED-733 | Iobenguane I-131 (Azedra) | 3/26/25 | 5/10/25 | Pending | Iobenguane I-131 (Azedra) |
| 2025-LHCC-MED-734 | Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) | 3/26/25 | 5/10/25 | Pending | Pertuzumab/Trastuzumab/Hyaluronidase-zzxf (Phesgo) |
| 2025-LHCC-MED-735 | Interferon Gamma-1b (Actimmune) | 3/26/25 | 5/10/25 | Pending | Interferon Gamma-1b (Actimmune) |
| 2025-LHCC-MED-736 | Sirolimus Protein-Bound Particles (Fyarro) | 3/26/25 | 5/10/25 | Pending | Sirolimus Protein-Bound Particles (Fyarro) |
| 2025-LHCC-MED-737 | Thyrotropin Alfa (Thyrogen) | 3/26/25 | 5/10/25 | Pending | Thyrotropin Alfa (Thyrogen) |
| 2025-LHCC-MED-738 | Zilucoplan (Zilbrysq) | 3/26/25 | 5/10/25 | Pending | Zilucoplan (Zilbrysq) |
| 2025-LHCC-MED-739 | Parathyroid Hormone (Natpara) | 3/26/25 | 5/10/25 | Pending | Parathyroid Hormone (Natpara) |
| 2025-LHCC-MED-740 | Hemin (Panhematin) | 3/26/25 | 5/10/25 | Pending | Hemin (Panhematin) |
| 2025-LHCC-MED-741 | Mosunetuzumab-axgb (Lunsumio) | 3/26/25 | 5/10/25 | Pending | Mosunetuzumab-axgb (Lunsumio) |
| 2025-LHCC-MED-742 | Naxitamab-gqgk (Danyelza) | 3/26/25 | 5/10/25 | Pending | Naxitamab-gqgk (Danyelza) |
| 2025-LHCC-MED-730 | Afamitresgene autoleucel (Tecelra) | 3/26/25 | 5/10/25 | Pending | Afamitresgene autoleucel (Tecelra) |
| 2025-LHCC-MED-743 | Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) | 3/26/25 | 5/10/25 | Pending | Rituximab (Rituxan), Rituximab-arrx (Riabni), Rituximab-pvvr (Ruxience), Rituximab-abbs (Truxima), Rituximab-Hyaluronidase (Rituxan Hycela) |
| 2025-LHCC-MED-744 | Blinatumomab (Blincyto) | 3/26/25 | 5/10/25 | Pending | Blinatumomab (Blincyto) |
| 2025-LHCC-MED-745 | Sacituzumab Govitecan-hziy (Trodelvy) | 3/26/25 | 5/10/25 | Pending | Sacituzumab Govitecan-hziy (Trodelvy) |
| 2025-LHCC-MED-746 | Margetuximab-cmkb (Margenza) | 3/26/25 | 5/10/25 | Pending | Margetuximab-cmkb (Margenza) |
| 2025-LHCC-MED-747 | Talimogene laherepvec (Imlygic) | 3/26/25 | 5/10/25 | Pending | Talimogene laherepvec (Imlygic) |
| 2025-LHCC-MED-748 | Ropeginterferon Alfa-2b-njft (Besremi) | 3/26/25 | 5/10/25 | Pending | Ropeginterferon Alfa-2b-njft (Besremi) |
| 2025-LHCC-MED-749 | Inotersen (Tegsedi) | 3/25/25 | 5/9/25 | Pending | Inotersen (Tegsedi) |
| 2025-LHCC-MED-750 | Faricimab-svoa (Vabysmo) | 3/25/25 | 5/9/25 | Pending | Faricimab-svoa (Vabysmo) |
| 2025-LHCC-MED-751 | Plerixafor (Mozobil) | 3/25/25 | 5/9/25 | Pending | Plerixafor (Mozobil) |
| 2025-LHCC-MED-752 | Ravulizumab-cwvz (Ultomiris) | 3/25/25 | 5/9/25 | Pending | Ravulizumab-cwvz (Ultomiris) |
| 2025-LHCC-MED-753 | Avalglucosidase Alfa-ngpt (Nexviazyme) | 3/25/25 | 5/9/25 | Pending | Avalglucosidase Alfa-ngpt (Nexviazyme) |
| 2025-LHCC-MED-754 | Afamelanotide (Scenesse) | 3/25/25 | 5/9/25 | Pending | Afamelanotide (Scenesse) |
| 2025-LHCC-MED-755 | Brolucizumab-dbll (Beovu) | 3/25/25 | 5/9/25 | Pending | Brolucizumab-dbll (Beovu) |
| 2025-HB-MED-506 | Jemperli | 3/25/25 | 5/9/25 | Pending | Jemperli |
| 2025-HB-MED-507 | Kyprolis | 3/25/25 | 5/9/25 | Pending | Kyprolis |
| 2025-HB-MED-508 | Loqtorzi | 3/25/25 | 5/9/25 | Pending | Loqtorzi |
| 2025-HB-MED-509 | Rybrevant | 3/25/25 | 5/9/25 | Pending | Rybrevant |
| 2025-HB-MED-510 | Abecma | 3/25/25 | 5/9/25 | Pending | Abecma |
| 2025-HB-MED-511 | Akynzeo for injection | 3/25/25 | 5/9/25 | Pending | Akynzeo for injection |
| 2025-HB-MED-512 | Alpha-1 Proteinase inhibitor | 3/25/25 | 5/9/25 | Pending | Alpha-1 Proteinase inhibitor |
| 2025-HB-MED-513 | Amtagvi | 3/25/25 | 5/9/25 | Pending | Amtagvi |
| 2025-HB-MED-514 | Aucatzyl | 3/25/25 | 5/9/25 | Pending | Aucatzyl |
| 2025-HB-MED-515 | Bendamustine | 3/25/25 | 5/9/25 | Pending | Bendamustine |
| 2025-HB-MED-516 | Imfinzi | 3/25/25 | 5/9/25 | Pending | Imfinzi |
| 2025-HB-MED-518 | Octreotide Agents | 3/25/25 | 5/9/25 | Pending | Octreotide Agents |
| 2025-HB-MED-519 | Strensiq | 3/25/25 | 5/9/25 | Pending | Strensiq |
| 2025-HB-MED-505 | Piasky | 3/25/25 | 5/9/25 | Pending | Piasky |
| 2025-UHC-MED-236 | Edaravone | 3/25/25 | 5/9/25 | Pending | Edaravone |
| 2025-UHC-MED-237 | Enjaymo | 3/25/25 | 5/9/25 | Pending | Enjaymo |
| 2025-PHARM-72 | Louisiana Medicaid ICD-10 Chart May1 | 3/14/25 | 4/28/25 | Pending | Louisiana Medicaid ICD-10 Chart May1 |
| 2025-PHARM-73 | POS Oncology - Oral Prostate | 3/14/25 | 4/28/25 | Pending | POS Oncology - Oral Prostate |
| 2025-PHARM-65 | POS Androgenic Agents | 3/12/25 | 4/26/25 | Pending | POS Androgenic Agents |
| 2025-PHARM-66 | POS Estrogenic Agents and Combos | 3/12/25 | 4/26/25 | Pending | POS Estrogenic Agents and Combos |
| 2025-PHARM-67 | POS Progestational Agents | 3/12/25 | 4/26/25 | Pending | POS Progestational Agents |
| 2025-PHARM-68 | POS Progestational Agents, Other | 3/12/25 | 4/26/25 | Pending | POS Progestational Agents, Other |
| 2025-PHARM-69 | POS Prostate - BPH Treatment | 3/12/25 | 4/26/25 | Pending | POS Prostate - BPH Treatment |
| 2025-PHARM-70 | POS Spironolactone | 3/12/25 | 4/26/25 | Pending | POS Spironolactone |
| 2025-PHARM-71 | POS Testosterone, Oral/Injectable | 3/12/25 | 4/26/25 | Pending | POS Testosterone, Oral/Injectable |
| 2025-PHARM-33 | Alyftrek | 3/10/25 | 4/24/25 | Pending | Alyftrek |
| 2025-PHARM-34 | Attruby | 3/10/25 | 4/24/25 | Pending | Attruby |
| 2025-PHARM-35 | Crenessity | 3/10/25 | 4/24/25 | Pending | Crenessity |
| 2025-PHARM-36 | Davimet | 3/10/25 | 4/24/25 | Pending | Davimet |
| 2025-PHARM-37 | Depression-Antidepressants, Other | 3/10/25 | 4/24/25 | Pending | Depression-Antidepressants, Other |
| 2025-PHARM-38 | Lidotral | 3/10/25 | 4/24/25 | Pending | Lidotral |
| 2025-PHARM-39 | Louisiana Medicaid ICD-10 Chart | 3/10/25 | 4/24/25 | Pending | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-40 | Multitam | 3/10/25 | 4/24/25 | Pending | Multitam |
| 2025-PHARM-41 | Oxervate | 3/10/25 | 4/24/25 | Pending | Oxervate |
| 2025-PHARM-42 | Pain Management - Cytokine/CAM Antagonists | 3/10/25 | 4/24/25 | Pending | Pain Management - Cytokine/CAM Antagonists |
| 2025-PHARM-43 | POS ADD-ADHD Stimulants and Related Agents | 3/10/25 | 4/24/25 | Pending | POS ADD-ADHD Stimulants and Related Agents |
| 2025-PHARM-44 | POS Alhemo | 3/10/25 | 4/24/25 | Pending | POS Alhemo |
| 2025-PHARM-45 | POS Allergy - Rhinitis Agents, Nasal | 3/10/25 | 4/24/25 | Pending | POS Allergy - Rhinitis Agents, Nasal |
| 2025-PHARM-46 | POS Antipsychotic Agents, Oral/Transdermal | 3/10/25 | 4/24/25 | Pending | POS Antipsychotic Agents, Oral/Transdermal |
| 2025-PHARM-47 | POS Asthma/COPD Bronchodilator, Beta Adrenergic Agents | 3/10/25 | 4/24/25 | Pending | POS Asthma/COPD Bronchodilator, Beta Adrenergic Agents |
| 2025-PHARM-48 | POS Attruby | 3/10/25 | 4/24/25 | Pending | POS Attruby |
| 2025-PHARM-49 | POS Butalbital-Containing Agents | 3/10/25 | 4/24/25 | Pending | POS Butalbital-Containing Agents |
| 2025-PHARM-50 | POS Davimet | 3/10/25 | 4/24/25 | Pending | POS Davimet |
| 2025-PHARM-51 | POS Dermatology - Antipsoriatics, Topical | 3/10/25 | 4/24/25 | Pending | POS Dermatology - Antipsoriatics, Topical |
| 2025-PHARM-52 | POS Diabetes - Glucagon Agents | 3/10/25 | 4/24/25 | Pending | POS Diabetes - Glucagon Agents |
| 2025-PHARM-53 | POS Diabetes - Hypoglycemics, SGLT2 Inhibitors | 3/10/25 | 4/24/25 | Pending | POS Diabetes - Hypoglycemics, SGLT2 Inhibitors |
| 2025-PHARM-54 | POS Hympavzi | 3/10/25 | 4/24/25 | Pending | POS Hympavzi |
| 2025-PHARM-55 | POS Inhaler Spacers | 3/10/25 | 4/24/25 | Pending | POS Inhaler Spacers |
| 2025-PHARM-56 | POS Lidocaine/Prilocaine | 3/10/25 | 4/24/25 | Pending | POS Lidocaine/Prilocaine |
| 2025-PHARM-57 | POS Multitam | 3/10/25 | 4/24/25 | Pending | POS Multitam |
| 2025-PHARM-58 | POS Ryvent | 3/10/25 | 4/24/25 | Pending | POS Ryvent |
| 2025-PHARM-59 | POS Smoking Cessation Products | 3/10/25 | 4/24/25 | Pending | POS Smoking Cessation Products |
| 2025-PHARM-60 | POS Sofdra | 3/10/25 | 4/24/25 | Pending | POS Sofdra |
| 2025-PHARM-61 | POS Urology - Incontinence Bladder Relaxant Preparations | 3/10/25 | 4/24/25 | Pending | POS Urology - Incontinence Bladder Relaxant Preparations |
| 2025-PHARM-62 | Sofdra | 3/10/25 | 4/24/25 | Pending | Sofdra |
| 2025-PHARM-63 | Vyalev | 3/10/25 | 4/24/25 | Pending | Vyalev |
| 2025-PHARM-64 | Yesintek | 3/10/25 | 4/24/25 | Pending | Yesintek |
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.
Related Info
- Previously posted for public comment
- Managed Care Pharmacy and Medical Drug Policies - Archive (2024)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2023)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2022)
- Managed Care Pharmacy and Medical Drug Policies - Archive (2021 and prior)
- Public comments submitted