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| Item Number | Policy/Procedure Date Posted Comment Period Closed Status | Date Posted Comment Period Closed Status | Comment Period Closed Status | Status | Document Links |
|---|---|---|---|---|---|
| 2025-PHARM-118 | Elevidys | 6/27/25 | N/A | Approved | Elevidys Met Imminent Peril Justification |
| 2025-HUMANA-MED-110 | Adstiladrin (nadofaragene firadenovec-vncg) | 6/27/25 | 8/11/25 | Pending | Adstiladrin (nadofaragene firadenovec-vncg) |
| 2025-HUMANA-MED-111 | Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®) | 6/27/25 | 8/11/25 | Pending | Alpha-1 Proteinase Inhibitors (Prolastin-C®, Zemaira®) |
| 2025-HUMANA-MED-112 | Byooviz™ (ranibizumab-nuna) | 6/27/25 | 8/11/25 | Pending | Byooviz™ (ranibizumab-nuna) |
| 2025-HUMANA-MED-113 | Intravenous Iron Products | 6/27/25 | 8/11/25 | Pending | Intravenous Iron Products |
| 2025-HUMANA-MED-114 | Lucentis® (ranibizumab) | 6/27/25 | 8/11/25 | Pending | Lucentis® (ranibizumab) |
| 2025-HUMANA-MED-115 | Luxturna® (voretigene neparvovec-rzyl) | 6/27/25 | 8/11/25 | Pending | Luxturna® (voretigene neparvovec-rzyl) |
| 2025-HUMANA-MED-116 | Panhematin® (heme for injection) intravenous solution | 6/27/25 | 8/11/25 | Pending | Panhematin® (heme for injection) intravenous solution |
| 2025-HUMANA-MED-117 | Susvimo® (ranibizumab) | 6/27/25 | 8/11/25 | Pending | Susvimo® (ranibizumab) |
| 2025-HUMANA-MED-118 | Tivdak (tisotumab vedotin-tftv) | 6/27/25 | 8/11/25 | Pending | Tivdak (tisotumab vedotin-tftv) |
| 2025-HUMANA-MED-119 | Viscosupplements | 6/27/25 | 8/11/25 | Pending | Viscosupplements |
| 2025-HUMANA-MED-120 | Visudyne® (verteporfin) | 6/27/25 | 8/11/25 | Pending | Visudyne® (verteporfin) |
| 2025-HUMANA-MED-121 | Xgeva® (denosumab) | 6/27/25 | 8/11/25 | Pending | Xgeva® (denosumab) |
| 2025-HUMANA-MED-122 | Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) | 6/27/25 | 8/11/25 | Pending | Aflibercept Products (Eylea®, Eylea® HD, Pavblu™) |
| 2025-HUMANA-MED-123 | Yescarta™ (axicabtagene ciloleucel) | 6/27/25 | 8/11/25 | Pending | Yescarta™ (axicabtagene ciloleucel) |
| 2025-HUMANA-MED-124 | Opdualag (nivolumab and relatlimab-rmbw) | 6/27/25 | 8/11/25 | Pending | Opdualag (nivolumab and relatlimab-rmbw) |
| 2025-LHCC-MED-807 | Pertuzumab (Perjeta) | 6/24/25 | 8/8/25 | Pending | Pertuzumab (Perjeta) |
| 2025-LHCC-MED-808 | Ado-Trastuzumab Emtansine (Kadcyla) | 6/24/25 | 8/8/25 | Pending | Ado-Trastuzumab Emtansine (Kadcyla) |
| 2025-LHCC-MED-809 | Cabazitaxel (Jevtana) | 6/24/25 | 8/8/25 | Pending | Cabazitaxel (Jevtana) |
| 2025-LHCC-MED-810 | Ipilimumab (Yervoy) | 6/24/25 | 8/8/25 | Pending | Ipilimumab (Yervoy) |
| 2025-LHCC-MED-811 | Patisiran (Onpattro) | 6/24/25 | 8/8/25 | Pending | Patisiran (Onpattro) |
| 2025-LHCC-MED-812 | Dexrazoxane (Zinecard, Totect) | 6/24/25 | 8/8/25 | Pending | Dexrazoxane (Zinecard, Totect) |
| 2025-LHCC-MED-813 | Edaravone (Radicava, Radivaca ORS) | 6/24/25 | 8/8/25 | Pending | Edaravone (Radicava, Radivaca ORS) |
| 2025-LHCC-MED-814 | Pozelimab-bbfg (Veopoz) | 6/24/25 | 8/8/25 | Pending | Pozelimab-bbfg (Veopoz) |
| 2025-LHCC-MED-815 | Lisocabtagene Maraleucel (Breyanzi) | 6/24/25 | 8/8/25 | Pending | Lisocabtagene Maraleucel (Breyanzi) |
| 2025-LHCC-MED-816 | Mitoxantrone | 6/24/25 | 8/8/25 | Pending | Mitoxantrone |
| 2025-LHCC-MED-817 | Denileukin Diftitox-cxdl (Lymphir) | 6/24/25 | 8/8/25 | Pending | Denileukin Diftitox-cxdl (Lymphir) |
| 2025-LHCC-MED-818 | Teclistamab-cqyv (Tecvayli) | 6/24/25 | 8/8/25 | Pending | Teclistamab-cqyv (Tecvayli) |
| 2025-LHCC-MED-819 | Mirvetuximab soravatansine-gynx (Elahere) | 6/24/25 | 8/8/25 | Pending | Mirvetuximab soravatansine-gynx (Elahere) |
| 2025-LHCC-MED-821 | Zolbetuximab-clzb (Vyloy) | 6/24/25 | 8/8/25 | Pending | Zolbetuximab-clzb (Vyloy) |
| 2025-LHCC-MED-822 | Zanidatamab-hrii (Ziihera) | 6/24/25 | 8/8/25 | Pending | Zanidatamab-hrii (Ziihera) |
| 2025-HB-MED-538 | Select Clotting Agents for Bleeding Disorders | 6/24/25 | 8/8/25 | Pending | Select Clotting Agents for Bleeding Disorders |
| 2025-UHC-MED-248 | Oncology medication clinical coverage policy | 6/24/25 | 8/8/25 | Pending | Oncology medication clinical coverage policy |
| 2025-ACLA-MED-107 | Myasthenia Gravis Agents | 6/24/25 | 8/8/25 | Pending | Myasthenia Gravis Agents |
| 2025-ACLA-MED-108 | Radicava | 6/24/25 | 8/8/25 | Pending | Radicava |
| 2025-ACLA-MED-109 | Specialty Drugs PA Criteria | 6/24/25 | 8/8/25 | Pending | Specialty Drugs PA Criteria |
| 2025-ACLA-MED-110 | Somatostatin Analogs | 6/24/25 | 8/8/25 | Pending | Somatostatin Analogs |
| 2025-HB-MED-527 | Rx Med PA Algn-SF 857 | 6/11/25 | 7/26/25 | Pending | Rx Med PA Algn-SF 857 |
| 2025-HB-MED-530 | Kanuma (sebelipase alfa) | 6/11/25 | 7/26/25 | Pending | Kanuma (sebelipase alfa) |
| 2025-HB-MED-531 | Scenesse (afamelanotide) | 6/11/25 | 7/26/25 | Pending | Scenesse (afamelanotide) |
| 2025-HB-MED-532 | Izervay (avacincaptad pegol) | 6/11/25 | 7/26/25 | Pending | Izervay (avacincaptad pegol) |
| 2025-HB-MED-533 | Jemperli (dostarlimab-gxly) | 6/11/25 | 7/26/25 | Pending | Jemperli (dostarlimab-gxly) |
| 2025-HB-MED-534 | Erbitux (cetuximab) | 6/11/25 | 7/26/25 | Pending | Erbitux (cetuximab) |
| 2025-HB-MED-535 | Denosumab | 6/11/25 | 7/26/25 | Pending | Denosumab |
| 2025-HB-MED-536 | Ketamine injection (Ketalar) | 6/11/25 | 7/26/25 | Pending | Ketamine injection (Ketalar) |
| 2025-PHARM-116 | Lyfgenia | 6/10/25 | 7/25/25 | Pending | Lyfgenia |
| 2025-PHARM-117 | PDL July 1, 2025 | 6/10/25 | 7/25/25 | Pending | PDL July 1, 2025 |
| 2025-PHARM-74 | Allergy - Nasal Rhinitis Agents | 6/4/25 | 7/19/25 | Pending | Allergy - Nasal Rhinitis Agents |
| 2025-PHARM-75 | Asthma-COPD, Inhaled Glucocorticoids | 6/4/25 | 7/19/25 | Pending | Asthma-COPD, Inhaled Glucocorticoids |
| 2025-PHARM-76 | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers | 6/4/25 | 7/19/25 | Pending | Diabetes - Hypoglycemics, Incretin Mimetics/Enhancers |
| 2025-PHARM-77 | Digestive Disorders - Bile Acid Salts | 6/4/25 | 7/19/25 | Pending | Digestive Disorders - Bile Acid Salts |
| 2025-PHARM-78 | GI Motility, Chronic | 6/4/25 | 7/19/25 | Pending | GI Motility, Chronic |
| 2025-PHARM-79 | Infectious Disorders - Oxazolidinones | 6/4/25 | 7/19/25 | Pending | Infectious Disorders - Oxazolidinones |
| 2025-PHARM-80 | Louisiana Medicaid ICD-10 Chart | 6/4/25 | 7/19/25 | Pending | Louisiana Medicaid ICD-10 Chart |
| 2025-PHARM-81 | Niktimvo | 6/4/25 | 7/19/25 | Pending | Niktimvo |
| 2025-PHARM-82 | Onapgo | 6/4/25 | 7/19/25 | Pending | Onapgo |
| 2025-PHARM-83 | Pain Management - Antimigraine Agents, CGRP Antagonists | 6/4/25 | 7/19/25 | Pending | Pain Management - Antimigraine Agents, CGRP Antagonists |
| 2025-PHARM-84 | Pain Management - Cytokine/CAM Antagonists | 6/4/25 | 7/19/25 | Pending | Pain Management - Cytokine/CAM Antagonists |
| 2025-PHARM-85 | Pain Management - Neuropathic Pain | 6/4/25 | 7/19/25 | Pending | Pain Management - Neuropathic Pain |
| 2025-PHARM-86 | Pain Management - Skeletal Muscle Relaxants | 6/4/25 | 7/19/25 | Pending | Pain Management - Skeletal Muscle Relaxants |
| 2025-PHARM-87 | POS ADD-ADHD Stimulants and Related Agents | 6/4/25 | 7/19/25 | Pending | POS ADD-ADHD Stimulants and Related Agents |
| 2025-PHARM-88 | POS Allergy - Antihistamines, Minimally Sedating | 6/4/25 | 7/19/25 | Pending | POS Allergy - Antihistamines, Minimally Sedating |
| 2025-PHARM-89 | POS Antipsychotic Agents, Oral/Transdermal | 6/4/25 | 7/19/25 | Pending | POS Antipsychotic Agents, Oral/Transdermal |
| 2025-PHARM-90 | POS Asthma/COPD - Glucocorticoids, Inhalation | 6/4/25 | 7/19/25 | Pending | POS Asthma/COPD - Glucocorticoids, Inhalation |
| 2025-PHARM-91 | POS Asthma/COPD - Immunomodulators | 6/4/25 | 7/19/25 | Pending | POS Asthma/COPD - Immunomodulators |
| 2025-PHARM-92 | POS Asthma/COPD - Leukotriene Modifiers | 6/4/25 | 7/19/25 | Pending | POS Asthma/COPD - Leukotriene Modifiers |
| 2025-PHARM-93 | POS Bkemv | 6/4/25 | 7/19/25 | Pending | POS Bkemv |
| 2025-PHARM-94 | POS Cystic Fibrosis, Oral | 6/4/25 | 7/19/25 | Pending | POS Cystic Fibrosis, Oral |
| 2025-PHARM-95 | POS. Dermatology - Atopic Dermatitis, Immunomodulators | 6/4/25 | 7/19/25 | Pending | POS. Dermatology - Atopic Dermatitis, Immunomodulators |
| 2025-PHARM-96 | POS Digestive Disorders - Bile Acid Salts | 6/4/25 | 7/19/25 | Pending | POS Digestive Disorders - Bile Acid Salts |
| 2025-PHARM-97 | POS GI Motility, Chronic | 6/4/25 | 7/19/25 | Pending | POS GI Motility, Chronic |
| 2025-PHARM-98 | POS Journavx | 6/4/25 | 7/19/25 | Pending | POS Journavx |
| 2025-PHARM-99 | POS Opiate Dependence Agents | 6/4/25 | 7/19/25 | Pending | POS Opiate Dependence Agents |
| 2025-PHARM-100 | POS Pain Management - Neuropathic Pain | 6/4/25 | 7/19/25 | Pending | POS Pain Management - Neuropathic Pain |
| 2025-PHARM-101 | POS Pain Management - Nonsteroidal Anti-Inflammatory Drugs | 6/4/25 | 7/19/25 | Pending | POS Pain Management - Nonsteroidal Anti-Inflammatory Drugs |
| 2025-PHARM-102 | POS Potassium Binders | 6/4/25 | 7/19/25 | Pending | POS Potassium Binders |
| 2025-PHARM-103 | POS Ryclora | 6/4/25 | 7/19/25 | Pending | POS Ryclora |
| 2025-PHARM-104 | POS Spinal Muscular Atrophy | 6/4/25 | 7/19/25 | Pending | POS Spinal Muscular Atrophy |
| 2025-PHARM-105 | POS Tryvio | 6/4/25 | 7/19/25 | Pending | POS Tryvio |
| 2025-PHARM-106 | POS Veozah | 6/4/25 | 7/19/25 | Pending | POS Veozah |
| 2025-PHARM-107 | POS Voydeya | 6/4/25 | 7/19/25 | Pending | POS Voydeya |
| 2025-PHARM-108 | POS Yorvipath | 6/4/25 | 7/19/25 | Pending | POS Yorvipath |
| 2025-PHARM-109 | Potassium Binders | 6/4/25 | 7/19/25 | Pending | Potassium Binders |
| 2025-PHARM-110 | Ryclora | 6/4/25 | 7/19/25 | Pending | Ryclora |
| 2025-PHARM-111 | Tryngolza | 6/4/25 | 7/19/25 | Pending | Tryngolza |
| 2025-PHARM-112 | Tryvio | 6/4/25 | 7/19/25 | Pending | Tryvio |
| 2025-PHARM-113 | Veozah | 6/4/25 | 7/19/25 | Pending | Veozah |
| 2025-PHARM-114 | Voydeya | 6/4/25 | 7/19/25 | Pending | Voydeya |
| 2025-PHARM-115 | Yorvipath | 6/4/25 | 7/19/25 | Pending | Yorvipath |
| 2025-HB-MED-528 | Rx Eylea Biosim Med | 5/23/25 | 7/7/25 | Pending | Rx Eylea Biosim Med |
| 2025-ACLA-MED-98 | Adzynma | 5/23/25 | 7/7/25 | Pending | Adzynma |
| 2025-ACLA-MED-99 | Amtagvi | 5/23/25 | 7/7/25 | Pending | Amtagvi |
| 2025-ACLA-MED-100 | Anti-CD19 CAT-T Immunotherapies | 5/23/25 | 7/7/25 | Pending | Anti-CD19 CAT-T Immunotherapies |
| 2025-ACLA-MED-101 | Blincyto | 5/23/25 | 7/7/25 | Pending | Blincyto |
| 2025-ACLA-MED-102 | Complement Inhibitors | 5/23/25 | 7/7/25 | Pending | Complement Inhibitors |
| 2025-ACLA-MED-103 | Dendritic Cell Tumor Peptide Immunotherapy | 5/23/25 | 7/7/25 | Pending | Dendritic Cell Tumor Peptide Immunotherapy |
| 2025-ACLA-MED-104 | Hydroxyprogesterone | 5/23/25 | 7/7/25 | Pending | Hydroxyprogesterone |
| 2025-ACLA-MED-105 | Kebilidi | 5/23/25 | 7/7/25 | Pending | Kebilidi |
| 2025-UHC-MED-244 | Medical therapies for enzyme deficiencies | 5/22/25 | 7/6/25 | Pending | Medical therapies for enzyme deficiencies |
| 2025-UHC-MED-245 | Maximum dosage and frequency | 5/22/25 | 7/6/25 | Pending | Maximum dosage and frequency |
| 2025-UHC-MED-246 | RNA-targeted therapies (Amvuttra, Onpattro) | 5/22/25 | 7/6/25 | Pending | RNA-targeted therapies (Amvuttra, Onpattro) |
| 2025-LHCC-MED-802 | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) | 5/22/25 | 7/6/25 | Pending | Ranibizumab (Byooviz, Cimerli, Lucentis, Susvimo) |
| 2025-LHCC-MED-803 | Brentuximab Vedotin (Adcetris) | 5/22/25 | 7/6/25 | Pending | Brentuximab Vedotin (Adcetris) |
| 2025-LHCC-MED-804 | Durvalumab (Imfinzi) | 5/22/25 | 7/6/25 | Pending | Durvalumab (Imfinzi) |
| 2025-LHCC-MED-805 | Eculizumab (Soliris) | 5/22/25 | 7/6/25 | Pending | Eculizumab (Soliris) |
| 2025-LHCC-MED-806 | Aflibercept (Eylea) | 5/22/25 | 7/6/25 | Pending | Aflibercept (Eylea) |
| 2025-LHCC-MED-790 | Eteclacalcetide (Parsabiv) | 5/21/25 | 7/5/25 | Pending | Eteclacalcetide (Parsabiv) |
| 2025-LHCC-MED-791 | Chloramphenicol Sodium Succinate | 5/21/25 | 7/5/25 | Pending | Chloramphenicol Sodium Succinate |
| 2025-LHCC-MED-792 | Olipudase Alfa-rpcp (Xenpozyme) | 5/21/25 | 7/5/25 | Pending | Olipudase Alfa-rpcp (Xenpozyme) |
| 2025-LHCC-MED-793 | Idecabtagene Vicleucel (Abecma) | 5/21/25 | 7/5/25 | Pending | Idecabtagene Vicleucel (Abecma) |
| 2025-LHCC-MED-794 | Collagenase Clostridium Histolyticum (Xiaflex) | 5/21/25 | 7/5/25 | Pending | Collagenase Clostridium Histolyticum (Xiaflex) |
| 2025-LHCC-MED-795 | Paricalcitol Injection (Zemplar) | 5/21/25 | 7/5/25 | Pending | Paricalcitol Injection (Zemplar) |
| 2025-LHCC-MED-796 | Lifileucel (Amtagvi) | 5/21/25 | 7/5/25 | Pending | Lifileucel (Amtagvi) |
| 2025-LHCC-MED-797 | Ferric Carboxymaltose (Injectafer) | 5/21/25 | 7/5/25 | Pending | Ferric Carboxymaltose (Injectafer) |
| 2025-LHCC-MED-798 | Toripalimab-tpzi (Loqtorzi) | 5/21/25 | 7/5/25 | Pending | Toripalimab-tpzi (Loqtorzi) |
| 2025-LHCC-MED-799 | Ferumoxytol (Feraheme) | 5/21/25 | 7/5/25 | Pending | Ferumoxytol (Feraheme) |
| 2025-LHCC-MED-800 | Siltuximab (Sylvant) | 5/21/25 | 7/5/25 | Pending | Siltuximab (Sylvant) |
| 2025-LHCC-MED-801 | Panitumumab (Vectibix) | 5/21/25 | 7/5/25 | Pending | Panitumumab (Vectibix) |
| 2025-HB-MED-523 | Unloxcyt (cosibelimab-ipdl) | 5/21/25 | 7/5/25 | Pending | Unloxcyt (cosibelimab-ipdl) |
| 2025-HB-MED-524 | Datroway (datopotamab deruxtecan-dlnk) | 5/21/25 | 7/5/25 | Pending | Datroway (datopotamab deruxtecan-dlnk) |
| 2025-HB-MED-525 | Grafapex (treosulfan) | 5/21/25 | 7/5/25 | Pending | Grafapex (treosulfan) |
| 2025-HB-MED-526 | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) | 5/21/25 | 7/5/25 | Pending | Opdivo Qvantig (nivolumab hyaluronidase-nvhy) |
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