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-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
2026-LHCC-MED-974	Epoprostenol (Flolan, Veletri)	4/8/26	5/23/26	Pending	Epoprostenol (Flolan, Veletri)
2026-LHCC-MED-975	Enfortumab Vedotin-ejfv (Padcev)	4/8/26	5/23/26	Pending	Enfortumab Vedotin-ejfv (Padcev)
2026-LHCC-MED-976	Verteporfin (Visudyne)	4/8/26	5/23/26	Pending	Verteporfin (Visudyne)
2026-LHCC-MED-977	Trabectedin (Yondelis)	4/8/26	5/23/26	Pending	Trabectedin (Yondelis)
2026-LHCC-MED-978	Avelumab (Bavencio)	4/8/26	5/23/26	Pending	Avelumab (Bavencio)
2026-LHCC-MED-979	Tisagenlecleucel (Kymriah)	4/8/26	5/23/26	Pending	Tisagenlecleucel (Kymriah)
2026-LHCC-MED-980	Voretigene Neparvovec-rzyl (Luxturna)	4/8/26	5/23/26	Pending	Voretigene Neparvovec-rzyl (Luxturna)
2026-LHCC-MED-981	Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa)	4/8/26	5/23/26	Pending	Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa)
2026-LHCC-MED-982	Toripalimab-tpzi (Loqtorzi)	4/8/26	5/23/26	Pending	Toripalimab-tpzi (Loqtorzi)
2026-LHCC-MED-983	Eladocagene Exuparvovec-tneq (Kebilidi)	4/8/26	5/23/26	Pending	Eladocagene Exuparvovec-tneq (Kebilidi)
2026-LHCC-MED-984	Siltuximab (Sylvant)	4/8/26	5/23/26	Pending	Siltuximab (Sylvant)
2026-LHCC-MED-985	Eteclacalcetide (Parsabiv)	4/8/26	5/23/26	Pending	Eteclacalcetide (Parsabiv)
2026-LHCC-MED-986	Paricalcitol Injection (Zemplar)	4/8/26	5/23/26	Pending	Paricalcitol Injection (Zemplar)
2026-LHCC-MED-987	Teclistamab-cqyv (Tecvayli)	4/8/26	5/23/26	Pending	Teclistamab-cqyv (Tecvayli)
2026-LHCC-MED-988	Linvoseltamab-gcpt (Lynozyfic)	4/8/26	5/23/26	Pending	Linvoseltamab-gcpt (Lynozyfic)
2026-LHCC-MED-989	Burosumab-twza (Crysvita)	4/8/26	5/23/26	Pending	Burosumab-twza (Crysvita)
2026-LHCC-MED-990	Ferric Derisomaltose (Monoferric)	4/8/26	5/23/26	Pending	Ferric Derisomaltose (Monoferric)
2026-LHCC-MED-991	Pertuzumab (Perjeta), Pertuzumab-dpzb (Poherdy)	4/8/26	5/23/26	Pending	Pertuzumab (Perjeta), Pertuzumab-dpzb (Poherdy)
2026-LHCC-MED-992	Datopotamab deruxtecan-dlnk (Datroway)	4/8/26	5/23/26	Pending	Datopotamab deruxtecan-dlnk (Datroway)
2026-LHCC-MED-963	Sodium thiosulfate (Pedmark)	4/8/26	5/23/26	Pending	Sodium thiosulfate (Pedmark)
2026-LHCC-MED-964	Alglucosidase Alfa (Lumizyme)	4/8/26	5/23/26	Pending	Alglucosidase Alfa (Lumizyme)
2026-LHCC-MED-965	Erwinia Asparaginase (Erwinaze, Rylaze)	4/8/26	5/23/26	Pending	Erwinia Asparaginase (Erwinaze, Rylaze)
2026-LHCC-MED-966	Protein C Concentrate, Human (Ceprotin)	4/8/26	5/23/26	Pending	Protein C Concentrate, Human (Ceprotin)
2026-LHCC-MED-967	Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda)	4/8/26	5/23/26	Pending	Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda)
2026-LHCC-MED-968	Mirvetuximab soravatansine-gynx (Elahere)	4/8/26	5/23/26	Pending	Mirvetuximab soravatansine-gynx (Elahere)
2026-LHCC-MED-969	Retifanlimab-dlwr (Zynyz)	4/8/26	5/23/26	Pending	Retifanlimab-dlwr (Zynyz)
2026-LHCC-MED-970	Zanidatamab-hrii (Ziihera)	4/8/26	5/23/26	Pending	Zanidatamab-hrii (Ziihera)
2026-LHCC-MED-971	Zolbetuximab-clzb (Vyloy)	4/8/26	5/23/26	Pending	Zolbetuximab-clzb (Vyloy)
2026-LHCC-MED-972	Antithrombin III (ATryn, Thrombate III)	4/8/26	5/23/26	Pending	Antithrombin III (ATryn, Thrombate III)
2026-LHCC-MED-973	Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro)	4/8/26	5/23/26	Pending	Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro)