Disease Management

The Louisiana Medicaid Pharmacy Benefits Management system uses state-of-the-art features to operate an outstanding disease state management program for its entire Medicaid Disease Management population. These features include:

  • Federally approved Medicaid Management Information (MMIS) system;
  • Web-based Clinical Drug Inquiry Support Application and Clinical Data Inquiry (e-CDI);
  • Prospective and Retrospective Drug Utilization Review Programs;
  • Prescribing Practitioner and Pharmacy Peer-Based Profiling Program; and
  • Recipient Prescription Lock-In Program

The pharmacy section contracts with its fiscal intermediary, Unisys, and the University of Louisiana at Monroe (ULM) School of Pharmacy to provide the administrative and technical support functions for the Disease Management Program.

Educational Tools:

Educational Brochures: The fiscal intermediary in conjunction with the ULM School of Pharmacy, produces and mails several educational brochures throughout the year. The brochures are disease-state specific brochures for prescribers and pharmacists in addition to brochures for recipients.

Educational Articles: The State's Medicaid provider newsletter, The Provider Update, published by the fiscal intermediary several times a year, includes educational articles for prescribers and pharmacists on various disease states and treatment modalities.

Program Initiatives:

The Disease State Management initiatives focus on diseases such as asthma, diabetes, arthritis, hyperlipidemia and heart failure. Outcomes studies on these initiatives are conducted by university staff. A report issued on a study of the Asthma Disease State Managment Program disclosed that as a result of the disease managment program, asthma-related physician office visits declined in all areas of the state; there was a decline in asthma-related inpatient utilization in all areas of the state; emergency room visits declined in three of the four regions of the state; there was an increase in the use of long-term control medications rather than quick-relief medications; and while pharmacy expenditures increased, the increases were accompanied by decreases in spending on other health services resulting in a decline in total asthma-related expenditures.