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 |
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