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-LHCC-MED-1014	Ipilimumab (Yervoy)	7/21/26	9/4/26	Pending	Ipilimumab (Yervoy)
2026-LHCC-MED-1015	Cabazitaxel (Jevtana)	7/21/26	9/4/26	Pending	Cabazitaxel (Jevtana)
2026-LHCC-MED-1016	Dexrazoxane	7/21/26	9/4/26	Pending	Dexrazoxane
2026-LHCC-MED-1017	Iptacopan (Fabhalta)	7/21/26	9/4/26	Pending	Iptacopan (Fabhalta)
2026-LHCC-MED-1018	Datopotamab deruxtecan-dlnk (Datroway)	7/21/26	9/4/26	Pending	Datopotamab deruxtecan-dlnk (Datroway)
2026-LHCC-MED-1019	Lutetium Lu 177 vipivotide tetraxetan (Pluvicto)	7/21/26	9/4/26	Pending	Lutetium Lu 177 vipivotide tetraxetan (Pluvicto)
2026-LHCC-MED-1020	Sipuleucel-T (Provenge)	7/21/26	9/4/26	Pending	Sipuleucel-T (Provenge)
2026-LHCC-MED-1021	Fibrinogen Concentrate [Human] (Fibryga, RiaSTAP), Fibrinogen, Human-chmt (Fesilty)	7/21/26	9/4/26	Pending	Fibrinogen Concentrate [Human] (Fibryga, RiaSTAP), Fibrinogen, Human-chmt (Fesilty)
2026-LHCC-MED-1022	Edaravone (Radicava, Radivaca ORS)	7/21/26	9/4/26	Pending	Edaravone (Radicava, Radivaca ORS)
2026-LHCC-MED-1023	Pozelimab-bbfg (Veopoz)	7/21/26	9/4/26	Pending	Pozelimab-bbfg (Veopoz)
2026-LHCC-MED-1024	Isatuximab-irfc (Sarclisa)	7/21/26	9/4/26	Pending	Isatuximab-irfc (Sarclisa)
2026-LHCC-MED-1025	Tebentafusp-tebn (Kimmtrak)	7/21/26	9/4/26	Pending	Tebentafusp-tebn (Kimmtrak)
2026-LHCC-MED-1026	Elapegademase-lvlr (Revcovi)	7/21/26	9/4/26	Pending	Elapegademase-lvlr (Revcovi)
2026-LHCC-MED-1027	Sebelipase Alfa (Kanuma)	7/21/26	9/4/26	Pending	Sebelipase Alfa (Kanuma)
2026-LHCC-MED-1028	Velmanase Alfa-tycv (Lamzede)	7/21/26	9/4/26	Pending	Velmanase Alfa-tycv (Lamzede)
2026-HB-MED-679	Arzerra (ofatumumab)	7/21/26	9/4/26	Pending	Arzerra (ofatumumab)
2026-HB-MED-680	Elzonris (tagraxofusp-erzs)	7/21/26	9/4/26	Pending	Elzonris (tagraxofusp-erzs)
2026-HB-MED-681	Mozobil (plerixafor)	7/21/26	9/4/26	Pending	Mozobil (plerixafor)
2026-HB-MED-682	Ixempra (ixabepilone)	7/21/26	9/4/26	Pending	Ixempra (ixabepilone)
2026-HB-MED-683	Pemetrexed	7/21/26	9/4/26	Pending	Pemetrexed
2026-HB-MED-684	Asparagine Specific Enzymes	7/21/26	9/4/26	Pending	Asparagine Specific Enzymes
2026-HB-MED-685	Abraxane (paclitaxel, protein bound)	7/21/26	9/4/26	Pending	Abraxane (paclitaxel, protein bound)
2026-HB-MED-686	Halaven (eribulin)	7/21/26	9/4/26	Pending	Halaven (eribulin)
2026-HB-MED-687	Zaltrap (ziv-aflibercept)	7/21/26	9/4/26	Pending	Zaltrap (ziv-aflibercept)
2026-HB-MED-688	Xofigo (Radium Ra 223 Dichloride)	7/21/26	9/4/26	Pending	Xofigo (Radium Ra 223 Dichloride)
2026-HB-MED-689	Kadcyla (ado-trastuzumab)	7/21/26	9/4/26	Pending	Kadcyla (ado-trastuzumab)
2026-HB-MED-690	Yuviwel (navepegritide	7/21/26	9/4/26	Pending	Yuviwel (navepegritide
2026-HB-MED-691	Loargys (pegzilarginase-nbln)	7/21/26	9/4/26	Pending	Loargys (pegzilarginase-nbln)
2026-HB-MED-692	Rebyota (fecal microbiota, live – jslm)	7/21/26	9/4/26	Pending	Rebyota (fecal microbiota, live – jslm)
2026-HB-MED-693	Revcovi (elapegademase-lvlr)	7/21/26	9/4/26	Pending	Revcovi (elapegademase-lvlr)
2026-HB-MED-694	Levoleucovorin and Leucovorin Agents	7/21/26	9/4/26	Pending	Levoleucovorin and Leucovorin Agents
2026-HB-MED-695	Keytruda (pembrolizumab)/ Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)	7/21/26	9/4/26	Pending	Keytruda (pembrolizumab)/ Keytruda Qlex (pembrolizumab and berahyaluronidase alfa-pmph)
2026-HB-MED-696	Darzalex (daratumumab) and Darzalex Faspro (daratumumab and hyaluronidase-fihj)	7/21/26	9/4/26	Pending	Darzalex (daratumumab) and Darzalex Faspro (daratumumab and hyaluronidase-fihj)
2026-HB-MED-697	Atezolizumab (Tecentriq, Tecentriq Hybreza)	7/21/26	9/4/26	Pending	Atezolizumab (Tecentriq, Tecentriq Hybreza)
2026-HB-MED-698	Somatuline Depot (lanreotide)	7/21/26	9/4/26	Pending	Somatuline Depot (lanreotide)
2026-HB-MED-699	Select Clotting Agents for Bleeding Disorders	7/21/26	9/4/26	Pending	Select Clotting Agents for Bleeding Disorders
2026-HB-MED-700	Scenesse (afamelanotide)	7/21/26	9/4/26	Pending	Scenesse (afamelanotide)
2026-HB-MED-701	Tecvayli (teclistamab-cqyv)	7/21/26	9/4/26	Pending	Tecvayli (teclistamab-cqyv)
2026-HB-MED-702	Imdelltra (tarlatamab-dlle)	7/21/26	9/4/26	Pending	Imdelltra (tarlatamab-dlle)
2026-HB-MED-703	Iron Agents	7/21/26	9/4/26	Pending	Iron Agents
2026-HB-MED-704	Pasireotide Agent: Signifor LAR (pasireotide)	7/21/26	9/4/26	Pending	Pasireotide Agent: Signifor LAR (pasireotide)
2026-HB-MED-705	Bynfezia Pen, Sandostatin, or Sandostatin LAR (Octreotide) / Octreotide Agents	7/21/26	9/4/26	Pending	Bynfezia Pen, Sandostatin, or Sandostatin LAR (Octreotide) / Octreotide Agents
2026-HUM-MED-189	HUM 9498- HCPCS - Pegfilgrastim and its biosimilars	7/21/26	9/4/26	Pending	HUM 9498- HCPCS - Pegfilgrastim and its biosimilars
2026-HUM-MED-190	HUM 9585- HCPCS - rituximab and its biosimilars	7/21/26	9/4/26	Pending	HUM 9585- HCPCS - rituximab and its biosimilars
2026-HUM-MED-191	HUM 9480- CPT - Pneumococcal vaccines limitations – CPT codes 90670, 90671 and 90677	7/21/26	9/4/26	Pending	HUM 9480- CPT - Pneumococcal vaccines limitations – CPT codes 90670, 90671 and 90677
2026-HUM-MED-192	HUM 9514- CPT - pneumococcal vaccine frequency	7/21/26	9/4/26	Pending	HUM 9514- CPT - pneumococcal vaccine frequency
2026-HB-MED-678	Lerochol	7/7/26	8/21/26	Pending	Lerochol