Managed Care Pharmacy and Medical Drug Policies

COVID-19 Update: Changes to Medicaid policy and procedure deemed of an imminent peril to the public health, safety, or welfare and requiring immediate approval, such as those related to COVID-19, are exempt from the legislative requirement to publish the proposed policy or procedure for public comment prior to implementation. To keep abreast of these exempted changes to policy and procedure related to COVID-19, refer to the Coronavirus (COVID-19) Medicaid Information website, which provides guidance to Medicaid providers and managed care organizations, emergency rules, and requests LDH has submitted to the Centers for Medicare & Medicaid Services (CMS). Broader information related to COVID-19 can be found at http://ldh.la.gov/Coronavirus/.

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 Document Links
2022-PHARM-56 POS Opiate Dependence Agents 5/19/22 7/3/22 Pending POS Opiate Dependence Agents
2022-LHCC-MED-110 Hyaluronate Derivatives 5/17/22 7/1/22 Pending Hyaluronate Derivatives
2022-LHCC-MED-113 Xgeva 5/17/22 7/1/22 Pending Xgeva
2022-LHCC-MED-114 Perjeta 5/17/22 7/1/22 Pending Perjeta
2022-LHCC-MED-115 Rituximab 5/17/22 7/1/22 Pending Rituximab
2022-LHCC-MED-116 Darzalex 5/17/22 7/1/22 Pending Darzalex
2022-LHCC-MED-117 Yervoy 5/17/22 7/1/22 Pending Yervoy
2022-LHCC-MED-118 Yescarta 5/17/22 7/1/22 Pending Yescarta
2022-LHCC-MED-119 Enhertu 5/17/22 7/1/22 Pending Enhertu
2022-HB-MED-135 Carvykti 5/17/22 7/1/22 Pending Carvykti
2022-HB-MED-136 Kimmtrak 5/17/22 7/1/22 Pending Kimmtrak
2022-HB-MED-137 Enjaymo 5/17/22 7/1/22 Pending Enjaymo
2022-HB-MED-138 Yervoy 5/17/22 7/1/22 Pending Yervoy
2022-HB-MED-139 Kyprolis 5/17/22 7/1/22 Pending Kyprolis
2022-HB-MED-140 Blincyto 5/17/22 7/1/22 Pending Blincyto
2022-HB-MED-141 Bavencio 5/17/22 7/1/22 Pending Bavencio
2022-HB-MED-142 Ixempra 5/17/22 7/1/22 Pending Ixempra
2022-HB-MED-143 Perjeta 5/17/22 7/1/22 Pending Perjeta
2022-HB-MED-144 Kadcyla 5/17/22 7/1/22 Pending Kadcyla
2022-HB-MED-145 Halaven 5/17/22 7/1/22 Pending Halaven
2022-HB-MED-146 Mylotarg 5/17/22 7/1/22 Pending Mylotarg
2022-HB-MED-147 Arzerra 5/17/22 7/1/22 Pending Arzerra
2022-HB-MED-148          Enhertu 5/17/22 7/1/22 Pending Enhertu
2022-PHARM-45 Anticonvulsants 5/13/22 6/27/22 Pending Anticonvulsants
2022-PHARM-46 Antimigraine - Triptans 5/13/22 6/27/22 Pending Antimigraine - Triptans
2022-PHARM-47 Antipsychotics 5/13/22 6/27/22 Pending Antipsychotics
2022-PHARM-48 Enzyme Replacement Agents 5/13/22 6/27/22 Pending Enzyme Replacement Agents
2022-PHARM-49 Hypertension - Sympatholytics 5/13/22 6/27/22 Pending Hypertension - Sympatholytics
2022-PHARM-50 LA Medicaid PDL 5/13/22 6/27/22 Pending LA Medicaid PDL
2022-PHARM-51 Multiple Sclerosis Agents 5/13/22 6/27/22 Pending Multiple Sclerosis Agents
2022-PHARM-52 Oncology - Renal Cell 5/13/22 6/27/22 Pending Oncology - Renal Cell
2022-PHARM-53 POS Opiate Dependence Agents 5/13/22 6/27/22 Pending POS Opiate Dependence Agents
2022-PHARM-54 Pulmonary Arterial Hypertension Agents 5/13/22 6/27/22 Pending Pulmonary Arterial Hypertension Agents
2022-PHARM-55 Smoking Cessation Products 5/13/22 6/27/22 Pending Smoking Cessation Products
2022-HB-MED-133 Opdivo 5/13/22 6/27/22 Pending Opdivo
2022-HB-MED-131 Jetrea 5/12/22 6/26/22 Pending Jetrea
2022-HB-MED-132 Kanuma 5/12/22 6/26/22 Pending Kanuma
2022-HB-MED-134 Scenesse 5/12/22 6/26/22 Pending Scenesse
2022-PHARM-44 Vyondys 53 5/4/22 6/18/22 Pending Vyondys 53
2022-PHARM-43 Viltepso 5/4/22 6/18/22 Pending Viltepso
2022-PHARM-42 Tramadol - Age-Related Criteria 5/4/22 6/18/22 Pending Tramadol - Age-Related Criteria
2022-PHARM-41 Tezspire 5/4/22 6/18/22 Pending Tezspire
2022-PHARM-40 Sickle Cell Anemia 5/4/22 6/18/22 Pending Sickle Cell Anemia
2022-PHARM-39 POS Sickle Cell Anemia 5/4/22 6/18/22 Pending POS Sickle Cell Anemia
2022-PHARM-38 POS Short-Acting Narcotics 5/4/22 6/18/22 Pending POS Short-Acting Narcotics
2022-PHARM-37 POS Opiate Dependence Agents 5/4/22 6/18/22 Pending POS Opiate Dependence Agents
2022-PHARM-36 POS Long-Acting Narcotics 5/4/22 6/18/22 Pending POS Long-Acting Narcotics
2022-PHARM-35 POS Hyperlipidemia -Lipotropics, other 5/4/22 6/18/22 Pending POS Hyperlipidemia -Lipotropics, other
2022-PHARM-34 POS Cytokine/CAM Antagonists 5/4/22 6/18/22 Pending POS Cytokine/CAM Antagonists
2022-PHARM-33 POS Anxiolytics 5/4/22 6/18/22 Pending POS Anxiolytics
2022-PHARM-32 POS Antipsychotics -Oral/Transdermal 5/4/22 6/18/22 Pending POS Antipsychotics -Oral/Transdermal
2022-PHARM-31 POS Anticonvulsants 5/4/22 6/18/22 Pending POS Anticonvulsants
2022-PHARM-30 POS Anticoagulants 5/4/22 6/18/22 Pending POS Anticoagulants
2022-PHARM-29 POS Acne Agents 5/4/22 6/18/22 Pending POS Acne Agents
2022-PHARM-28 Nuedexta 5/4/22 6/18/22 Pending Nuedexta
2022-PHARM-27 ICD-10 Chart 5/4/22 6/18/22 Pending ICD-10 Chart
2022-PHARM-26 Hyperlipidemia -Lipotropics, other 5/4/22 6/18/22 Pending Hyperlipidemia -Lipotropics, other
2022-PHARM-25 Growth Factors 5/4/22 6/18/22 Pending Growth Factors
2022-PHARM-24 Exondys 51 5/3/22 6/17/22 Pending Exondys 51
2022-PHARM-23 Cytokine/CAM Antagonists 5/3/22 6/17/22 Pending Cytokine/CAM Antagonists
2022-PHARM-22 Adbry 5/3/22 6/17/22 Pending Adbry
2022-PHARM-21 Acne Agents 5/3/22 6/17/22 Pending Acne Agents
2022-LHCC-MED-112 Paclitaxel protein-bound (Abraxane) 5/3/22 6/17/22 Pending Paclitaxel protein-bound (Abraxane)
2022-LHCC-MED-111 Octreotide (Sandostatin, Sandostatin LAR, Bynfezia)  5/3/22 6/17/22 Pending Octreotide (Sandostatin, Sandostatin LAR, Bynfezia) 
2022-UHC-MED-107 Vyvgart 5/3/22 6/17/22 Pending Vyvgart
2022-HB-MED-126         Fyarro 4/21/22 6/5/22 Pending Fyarro
2022-HB-MED-127        Besremi  4/21/22 6/5/22 Pending Besremi 
2022-HB-MED-128        Vyvgart 4/21/22 6/5/22 Pending Vyvgart
2022-HB-MED-129        Adbry 4/21/22 6/5/22 Pending Adbry
2022-HB-MED-130        Asparagine Specific Enzymes 4/21/22 6/5/22 Pending Asparagine Specific Enzymes
2022-ACLA-MED-37 Emergency Use Authorization COVID-19 4/12/22 5/27/22 Pending Emergency Use Authorization COVID-19
2022-HB-MED-124          Leqvio 4/11/22 5/26/22 Pending Leqvio
2022-HB-MED-125          Selective VEGF Inhibitor 4/11/22 5/26/22 Pending Selective VEGF Inhibitor
2022-HB-PHARM-5 Continuous Glucose Monitors 4/6/22 5/21/22 Pending Continuous Glucose Monitors

RELATED INFO