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-HB-MED-678	Lerochol	7/7/26	8/21/26	Pending	Lerochol
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	Complete	Amivantamab-vmjw (Rybrevant)
2026-LHCC-MED-994	Ramucirumab (Cyramza)	5/7/26	6/21/26	Complete	Ramucirumab (Cyramza)
2026-LHCC-MED-995	Tremelimumab-actl (Imjudo)	5/7/26	6/21/26	Complete	Tremelimumab-actl (Imjudo)
2026-LHCC-MED-996	Fam-Trastuzumab Deruxtecan-nxki (Enhertu)	5/7/26	6/21/26	Complete	Fam-Trastuzumab Deruxtecan-nxki (Enhertu)
2026-LHCC-MED-997	Furosemide (Furoscix)	5/7/26	6/21/26	Complete	Furosemide (Furoscix)
2026-LHCC-MED-998	Letermovir (Prevymis)	5/7/26	6/21/26	Complete	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	Complete	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	Complete	Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo)
2026-LHCC-MED-1001	Eculizumab (Soliris)	5/7/26	6/21/26	Complete	Eculizumab (Soliris)
2026-PHARM-38	Aqvesme	4/30/26	6/14/26	Complete	Aqvesme
2026-PHARM-39	Blujepa	4/30/26	6/14/26	Complete	Blujepa
2026-PHARM-40	Dermatology - Atopic Dermatitis, Immunomodulators	4/30/26	6/14/26	Complete	Dermatology - Atopic Dermatitis, Immunomodulators
2026-PHARM-41	Exdensur	4/30/26	6/14/26	Complete	Exdensur
2026-PHARM-42	Forzinity	4/30/26	6/14/26	Complete	Forzinity
2026-PHARM-43	Heart Disease - Hyperlipidemia, Lipotropics Other	4/30/26	6/14/26	Complete	Heart Disease - Hyperlipidemia, Lipotropics Other
2026-PHARM-44	Hereditary Angioedema	4/30/26	6/14/26	Complete	Hereditary Angioedema
2026-PHARM-45	Itvisma	4/30/26	6/14/26	Complete	Itvisma
2026-PHARM-46	Louisiana Medicaid ICD-10 Chart	4/30/26	6/14/26	Complete	Louisiana Medicaid ICD-10 Chart
2026-PHARM-47	Lynkuet	4/30/26	6/14/26	Complete	Lynkuet
2026-PHARM-48	Multivitamins	4/30/26	6/14/26	Complete	Multivitamins
2026-PHARM-49	Myqorzo	4/30/26	6/14/26	Complete	Myqorzo
2026-PHARM-50	Orlynvah	4/30/26	6/14/26	Complete	Orlynvah
2026-PHARM-51	Pain Management - Cytokine/CAM Antagonists	4/30/26	6/14/26	Complete	Pain Management - Cytokine/CAM Antagonists
2026-PHARM-52	Pain Management - Non-Steroidal AntiInflammatory Agents	4/30/26	6/14/26	Complete	Pain Management - Non-Steroidal AntiInflammatory Agents
2026-PHARM-53	Pain Management - Skeletal Muscle Relaxants	4/30/26	6/14/26	Complete	Pain Management - Skeletal Muscle Relaxants
2026-PHARM-54	Papzimeos	4/30/26	6/14/26	Complete	Papzimeos
2026-PHARM-55	Pediatric Multivitamins with Fluoride	4/30/26	6/14/26	Complete	Pediatric Multivitamins with Fluoride
2026-PHARM-56	POS ADD-ADHD Stimulants and Related Agents	4/30/26	6/14/26	Complete	POS ADD-ADHD Stimulants and Related Agents
2026-PHARM-57	POS Allergy - Antihistamines, Minimally Sedating	4/30/26	6/14/26	Complete	POS Allergy - Antihistamines, Minimally Sedating
2026-PHARM-58	POS Antipsychotic Agents, Oral/Transdermal	4/30/26	6/14/26	Complete	POS Antipsychotic Agents, Oral/Transdermal
2026-PHARM-59	POS Aqvesme	4/30/26	6/14/26	Complete	POS Aqvesme
2026-PHARM-60	POS Blujepa	4/30/26	6/14/26	Complete	POS Blujepa
2026-PHARM-61	POS Dermatology - Atopic Dermatitis, Immunomodulators	4/30/26	6/14/26	Complete	POS Dermatology - Atopic Dermatitis, Immunomodulators
2026-PHARM-62	POS Exdensur	4/30/26	6/14/26	Complete	POS Exdensur
2026-PHARM-63	POS Exxua	4/30/26	6/14/26	Complete	POS Exxua
2026-PHARM-64	POS Lynkuet	4/30/26	6/14/26	Complete	POS Lynkuet
2026-PHARM-65	POS Myqorzo	4/30/26	6/14/26	Complete	POS Myqorzo
2026-PHARM-66	POS Orlynvah	4/30/26	6/14/26	Complete	POS Orlynvah
2026-PHARM-67	POS Pain Management - Non-Steroidal AntiInflammatory Agents	4/30/26	6/14/26	Complete	POS Pain Management - Non-Steroidal AntiInflammatory Agents
2026-PHARM-68	POS Pain Management - Skeletal Muscle Relaxants	4/30/26	6/14/26	Complete	POS Pain Management - Skeletal Muscle Relaxants
2026-PHARM-69	POS Voyxact	4/30/26	6/14/26	Complete	POS Voyxact
2026-PHARM-70	POS Zepbound	4/30/26	6/14/26	Complete	POS Zepbound
2026-PHARM-71	Redemplo	4/30/26	6/14/26	Complete	Redemplo
2026-PHARM-72	Sedative/Hypnotics	4/30/26	6/14/26	Complete	Sedative/Hypnotics
2026-PHARM-73	Starjemza	4/30/26	6/14/26	Complete	Starjemza
2026-PHARM-74	Yartemlea	4/30/26	6/14/26	Complete	Yartemlea
2026-PHARM-75	Zycubo	4/30/26	6/14/26	Complete	Zycubo