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-HB-MED-666	Aliqopa (copanlisib)	3/12/26	4/26/26	Pending	Aliqopa (copanlisib)
2026-HB-MED-667	Tecartus (brexucabtagene autoleucel)	3/12/26	4/26/26	Pending	Tecartus (brexucabtagene autoleucel)
2026-HB-MED-668	Besremi (ropeginterferon alfa-2b-njft)	3/12/26	4/26/26	Pending	Besremi (ropeginterferon alfa-2b-njft)
2026-HB-MED-670	Tecvayli (teclistamab-cqyv)	3/12/26	4/26/26	Pending	Tecvayli (teclistamab-cqyv)
2026-HB-MED-671	Imjudo (tremelimumab-actl)	3/12/26	4/26/26	Pending	Imjudo (tremelimumab-actl)
2026-HB-MED-672	Talvey (talquetamab-tgvs)	3/12/26	4/26/26	Pending	Talvey (talquetamab-tgvs)
2026-HB-MED-673	Loqtorzi (toripalimab-tpzi)	3/12/26	4/26/26	Pending	Loqtorzi (toripalimab-tpzi)
2026-HB-MED-674	Aucatzyl (obecabtagene autoleucel)	3/12/26	4/26/26	Pending	Aucatzyl (obecabtagene autoleucel)
2026-HB-MED-675	Ziihera (zanidatamab-hrii)	3/12/26	4/26/26	Pending	Ziihera (zanidatamab-hrii)
2026-HB-MED-656	Forzinity (elamipretide)	3/12/26	4/26/26	Pending	Forzinity (elamipretide)
2026-HB-MED-657	Ethyol (amifostine)	3/12/26	4/26/26	Pending	Ethyol (amifostine)
2026-HB-MED-658	Fyarro (sirolimus albumin bound)	3/12/26	4/26/26	Pending	Fyarro (sirolimus albumin bound)
2026-HB-MED-659	Elrexfio (elranatamab-bcmm)	3/12/26	4/26/26	Pending	Elrexfio (elranatamab-bcmm)
2026-HB-MED-660	Radicava (edaravone)	3/12/26	4/26/26	Pending	Radicava (edaravone)
2026-HB-MED-661	Vascular Endothelial Growth Factor (VEGF) Inhibitors	3/12/26	4/26/26	Pending	Vascular Endothelial Growth Factor (VEGF) Inhibitors
2026-HB-MED-662	Alpha-1 Proteinase Inhibitor Therapy	3/12/26	4/26/26	Pending	Alpha-1 Proteinase Inhibitor Therapy
2026-HB-MED-663	Bendamustine agents	3/12/26	4/26/26	Pending	Bendamustine agents
2026-HB-MED-664	Kyprolis (carfilzomib)	3/12/26	4/26/26	Pending	Kyprolis (carfilzomib)
2026-HB-MED-665	Keytruda (pembrolizumab)	3/12/26	4/26/26	Pending	Keytruda (pembrolizumab)
2026-LHCC-MED-927	Ibandronate Injection (Boniva)	3/5/26	4/19/26	Pending	Ibandronate Injection (Boniva)
2026-LHCC-MED-928	Panitumumab (Vectibix)	3/5/26	4/19/26	Pending	Panitumumab (Vectibix)
2026-LHCC-MED-929	Durvalumab (Imfinzi)	3/5/26	4/19/26	Pending	Durvalumab (Imfinzi)
2026-LHCC-MED-930	Tislelizumab-jsgr (Tevimbra)	3/5/26	4/19/26	Pending	Tislelizumab-jsgr (Tevimbra)
2026-LHCC-MED-931	Cetuximab (Erbitux)	3/5/26	4/19/26	Pending	Cetuximab (Erbitux)
2026-LHCC-MED-932	Inotersen (Tegsedi)	3/5/26	4/19/26	Pending	Inotersen (Tegsedi)
2026-LHCC-MED-933	Agalsidase Beta (Fabrazyme)	3/5/26	4/19/26	Pending	Agalsidase Beta (Fabrazyme)
2026-LHCC-MED-934	Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev)	3/5/26	4/19/26	Pending	Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev)
2026-LHCC-MED-935	Epcoritamab-bysp (Epkinly)	3/5/26	4/19/26	Pending	Epcoritamab-bysp (Epkinly)
2026-LHCC-MED-936	Ferumoxytol (Feraheme)	3/5/26	4/19/26	Pending	Ferumoxytol (Feraheme)
2026-LHCC-MED-937	Off-Label Use	3/5/26	4/19/26	Pending	Off-Label Use
2026-LHCC-MED-938	No Coverage Criteria	3/5/26	4/19/26	Pending	No Coverage Criteria
2026-LHCC-MED-924	Hyaluronate Derivatives	3/4/26	4/18/26	Pending	Hyaluronate Derivatives
2026-LHCC-MED-925	Mitomycin Instillation Solution (Jelmyto, Zusduri)	3/4/26	4/18/26	Pending	Mitomycin Instillation Solution (Jelmyto, Zusduri)
2026-LHCC-MED-926	Nipocalimab-aahu (Imaavy)	3/4/26	4/18/26	Pending	Nipocalimab-aahu (Imaavy)
2026-LHCC-MED-918	Elotuzumab (Empliciti)	3/4/26	4/18/26	Pending	Elotuzumab (Empliciti)
2026-LHCC-MED-919	Tarlatamab-dlle (Imdelltra)	3/4/26	4/18/26	Pending	Tarlatamab-dlle (Imdelltra)
2026-LHCC-MED-920	Parathyroid hormone (Natpara)	3/4/26	4/18/26	Pending	Parathyroid hormone (Natpara)
2026-LHCC-MED-921	Trofinetide (Daybue, Daybue Stix)	3/4/26	4/18/26	Pending	Trofinetide (Daybue, Daybue Stix)
2026-LHCC-MED-922	Idecabtagene Vicleucel (Abecma)	3/4/26	4/18/26	Pending	Idecabtagene Vicleucel (Abecma)
2026-LHCC-MED-923	Afamitresgene Autoleucel (Tecelra)	3/4/26	4/18/26	Pending	Afamitresgene Autoleucel (Tecelra)
2026-ACLA-MED-129	Papzimeos	2/27/26	4/13/26	Pending	Papzimeos
2026-LHCC-MED-904	Valrubicin (Valstar)	2/9/26	3/26/26	Pending	Valrubicin (Valstar)
2026-LHCC-MED-905	Tafasitamab-cxix (Monjuvi)	2/9/26	3/26/26	Pending	Tafasitamab-cxix (Monjuvi)
2026-LHCC-MED-906	Irinotecan Liposome (Onivyde)	2/9/26	3/26/26	Pending	Irinotecan Liposome (Onivyde)
2026-LHCC-MED-907	Levoleucovorin (Fusilev, Khapzory)	2/9/26	3/26/26	Pending	Levoleucovorin (Fusilev, Khapzory)
2026-LHCC-MED-908	Eribulin Mesylate (Halaven)	2/9/26	3/26/26	Pending	Eribulin Mesylate (Halaven)
2026-LHCC-MED-909	Daunorubicin/Cytarabine (Vyxeos)	2/9/26	3/26/26	Pending	Daunorubicin/Cytarabine (Vyxeos)
2026-LHCC-MED-910	Leucovorin Injection	2/9/26	3/26/26	Pending	Leucovorin Injection
2026-LHCC-MED-911	Tofersen (Qalsody)	2/9/26	3/26/26	Pending	Tofersen (Qalsody)
2026-LHCC-MED-912	Obinutuzumab (Gazyva)	2/9/26	3/26/26	Pending	Obinutuzumab (Gazyva)
2026-LHCC-MED-913	Pralatrexate (Folotyn)	2/9/26	3/26/26	Pending	Pralatrexate (Folotyn)
2026-LHCC-MED-914	Antithymocyte Globulin (Atgam, Thymoglobulin)	2/9/26	3/26/26	Pending	Antithymocyte Globulin (Atgam, Thymoglobulin)
2026-LHCC-MED-915	Inotuzumab Ozogamicin (Besponsa)	2/9/26	3/26/26	Pending	Inotuzumab Ozogamicin (Besponsa)
2026-LHCC-MED-916	Tisotumab Vedotin-tftv (Tivdak)	2/9/26	3/26/26	Pending	Tisotumab Vedotin-tftv (Tivdak)
2026-LHCC-MED-917	Ofatumumab (Arzerra)	2/9/26	3/26/26	Pending	Ofatumumab (Arzerra)
2026-LHCC-MED-886	Avacincaptad pegol (Izervay)	2/9/26	3/26/26	Pending	Avacincaptad pegol (Izervay)
2026-LHCC-MED-887	Asfotase Alfa (Strensiq)	2/9/26	3/26/26	Pending	Asfotase Alfa (Strensiq)
2026-LHCC-MED-888	Azacitidine (Onureg, Vidaza)	2/9/26	3/26/26	Pending	Azacitidine (Onureg, Vidaza)
2026-LHCC-MED-889	Ravulizumab-cwvz (Ultomiris)	2/9/26	3/26/26	Pending	Ravulizumab-cwvz (Ultomiris)
2026-LHCC-MED-890	Cetuximab (Erbitux)	2/9/26	3/26/26	Pending	Cetuximab (Erbitux)
2026-LHCC-MED-891	Carfilzomib (Kyprolis)	2/9/26	3/26/26	Pending	Carfilzomib (Kyprolis)
2026-LHCC-MED-892	Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta)	2/9/26	3/26/26	Pending	Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta)
2026-LHCC-MED-893	Rozanolixizumab-noli (Rystiggo)	2/9/26	3/26/26	Pending	Rozanolixizumab-noli (Rystiggo)
2026-LHCC-MED-894	Talquetamab-tgvs (Talvey)	2/9/26	3/26/26	Pending	Talquetamab-tgvs (Talvey)
2026-LHCC-MED-895	Elranatamab-bcmm (Elrexfio)	2/9/26	3/26/26	Pending	Elranatamab-bcmm (Elrexfio)
2026-LHCC-MED-896	Melphalan (Hepzato)	2/9/26	3/26/26	Pending	Melphalan (Hepzato)
2026-LHCC-MED-873	Mogamulizumab-kpkc (Poteligeo)	2/9/26	3/26/26	Pending	Mogamulizumab-kpkc (Poteligeo)
2026-LHCC-MED-874	Pasireotide (Signifor, Signifor LAR)	2/9/26	3/26/26	Pending	Pasireotide (Signifor, Signifor LAR)
2026-LHCC-MED-875	Pegvisomant (Somavert)	2/9/26	3/26/26	Pending	Pegvisomant (Somavert)
2026-LHCC-MED-876	Lanreotide (Somatuline Depot)	2/9/26	3/26/26	Pending	Lanreotide (Somatuline Depot)
2026-LHCC-MED-877	Belatacept (Nulojix)	2/9/26	3/26/26	Pending	Belatacept (Nulojix)
2026-LHCC-MED-878	Necitumumab (Portrazza)	2/9/26	3/26/26	Pending	Necitumumab (Portrazza)
2026-LHCC-MED-879	Ziv-aflibercept (Zaltrap)	2/9/26	3/26/26	Pending	Ziv-aflibercept (Zaltrap)
2026-LHCC-MED-880	Plasminogen, Human-tvmh (Ryplazim)	2/9/26	3/26/26	Pending	Plasminogen, Human-tvmh (Ryplazim)
2026-LHCC-MED-881	Belinostat (Beleodaq)	2/9/26	3/26/26	Pending	Belinostat (Beleodaq)
2026-LHCC-MED-882	Romidepsin (Istodax)	2/9/26	3/26/26	Pending	Romidepsin (Istodax)
2026-LHCC-MED-883	Temsirolimus (Torisel)	2/9/26	3/26/26	Pending	Temsirolimus (Torisel)
2026-LHCC-MED-884	Pegaspargase (Oncaspar), Calaspargase Pegol-mknl	2/9/26	3/26/26	Pending	Pegaspargase (Oncaspar), Calaspargase Pegol-mknl
2026-LHCC-MED-885	Denileukin Diftitox-cxdl (Lymphir)	2/9/26	3/26/26	Pending	Denileukin Diftitox-cxdl (Lymphir)
2026-LHCC-MED-872	Zopapogene Imadenovec (Papzimeos)	2/6/26	3/23/26	Pending	Zopapogene Imadenovec (Papzimeos)
2026-LHCC-MED-897	Brexucabtagene Autoleucel (Tecartus)	2/6/26	3/23/26	Pending	Brexucabtagene Autoleucel (Tecartus)
2026-LHCC-MED-898	Talimogene laherepvec (Imlygic)	2/6/26	3/23/26	Pending	Talimogene laherepvec (Imlygic)
2026-LHCC-MED-899	Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase	2/6/26	3/23/26	Pending	Trastuzumab/Biosimilars, Trastuzumab-Hyaluronidase
2026-LHCC-MED-900	Atezolizumab (Tecentriq)	2/6/26	3/23/26	Pending	Atezolizumab (Tecentriq)
2026-LHCC-MED-901	Pemetrexed (Alimta, Pemfexy)	2/6/26	3/23/26	Pending	Pemetrexed (Alimta, Pemfexy)
2026-LHCC-MED-902	Cemiplimab-rwlc (Libtayo)	2/6/26	3/23/26	Pending	Cemiplimab-rwlc (Libtayo)
2026-LHCC-MED-903	Motixafortide (Aphexda)	2/6/26	3/23/26	Pending	Motixafortide (Aphexda)
2026-ACLA-MED-128	VEGF Inhibitors	2/6/26	3/23/26	Pending	VEGF Inhibitors
2026-PHARM-6	Asthma/COPD - Immunomodulators	2/6/26	3/23/26	Pending	Asthma/COPD - Immunomodulators
2026-PHARM-7	Avtozma	2/6/26	3/23/26	Pending	Avtozma
2026-PHARM-8	Brinsupri	2/6/26	3/23/26	Pending	Brinsupri
2026-PHARM-9	Casgevy	2/6/26	3/23/26	Pending	Casgevy
2026-PHARM-10	Dawnzera	2/6/26	3/23/26	Pending	Dawnzera
2026-PHARM-11	Ekterly	2/6/26	3/23/26	Pending	Ekterly
2026-PHARM-12	Exxua	2/6/26	3/23/26	Pending	Exxua
2026-PHARM-13	Heart Disease - Hyperlipidemia, Lipotropics Other	2/6/26	3/23/26	Pending	Heart Disease - Hyperlipidemia, Lipotropics Other
2026-PHARM-14	Jascayd	2/6/26	3/23/26	Pending	Jascayd
2026-PHARM-15	Louisiana Medicaid ICD-10 Chart	2/6/26	3/23/26	Pending	Louisiana Medicaid ICD-10 Chart
2026-PHARM-16	Nypozi	2/6/26	3/23/26	Pending	Nypozi
2026-PHARM-17	Oncology Agents - Oral Other	2/6/26	3/23/26	Pending	Oncology Agents - Oral Other
2026-PHARM-18	Pain Management - Antimigraine Agents, CGRP Antagonists	2/6/26	3/23/26	Pending	Pain Management - Antimigraine Agents, CGRP Antagonists
2026-PHARM-19	Pain Management - Cytokine/CAM Antagonists	2/6/26	3/23/26	Pending	Pain Management - Cytokine/CAM Antagonists
2026-PHARM-20	Pain Management - Skeletal Muscle Relaxants	2/6/26	3/23/26	Pending	Pain Management - Skeletal Muscle Relaxants
2026-PHARM-21	POS Anzupgo	2/6/26	3/23/26	Pending	POS Anzupgo
2026-PHARM-22	POS Asthma/COPD - Immunomodulators	2/6/26	3/23/26	Pending	POS Asthma/COPD - Immunomodulators
2026-PHARM-23	POS Brinsupri	2/6/26	3/23/26	Pending	POS Brinsupri
2026-PHARM-24	POS Dermatology - Antipsoriatics, Topical	2/6/26	3/23/26	Pending	POS Dermatology - Antipsoriatics, Topical
2026-PHARM-25	POS Empaveli	2/6/26	3/23/26	Pending	POS Empaveli
2026-PHARM-26	POS Exxua	2/6/26	3/23/26	Pending	POS Exxua
2026-PHARM-27	POS Heart Disease - Hyperlipidemia, Anticoagulants	2/6/26	3/23/26	Pending	POS Heart Disease - Hyperlipidemia, Anticoagulants
2026-PHARM-28	POS Jascayd	2/6/26	3/23/26	Pending	POS Jascayd
2026-PHARM-29	POS Kirsty	2/6/26	3/23/26	Pending	POS Kirsty
2026-PHARM-30	POS Oncology - Oral Other	2/6/26	3/23/26	Pending	POS Oncology - Oral Other
2026-PHARM-31	POS Pain Management - Skeletal Muscle Relaxants	2/6/26	3/23/26	Pending	POS Pain Management - Skeletal Muscle Relaxants
2026-PHARM-32	POS Rhapsido	2/6/26	3/23/26	Pending	POS Rhapsido
2026-PHARM-33	POS Zurnai	2/6/26	3/23/26	Pending	POS Zurnai
2026-PHARM-34	Rhapsido	2/6/26	3/23/26	Pending	Rhapsido
2026-PHARM-35	Sephience	2/6/26	3/23/26	Pending	Sephience
2026-PHARM-36	Tyruko	2/6/26	3/23/26	Pending	Tyruko
2026-PHARM-37	Vyjuvek	2/6/26	3/23/26	Pending	Vyjuvek
2026-PHARM-5	Max Dose Override Buprenorphine	2/2/26	3/19/26	Pending	Max Dose Override Buprenorphine