LETTER TO PROVIDERS


July 14, 2003

Dear Prescribing Practitioners and Pharmacy Providers:

Attached is a listing of drugs on the Medicaid Prior Authorization (PA) Process' Preferred Drug List (PDL). The listing includes preferred drugs and those drugs requiring prior authorization.

The PA process, in accordance with the program's "Continuity of Care" policy, does not impact original prescriptions (or refills) issued by a prescribing practitioner prior to effective PA dates of drugs as they are added to the PA process as long as they are within the 5 refills and 6-month program limits. An educational alert will notify the pharmacist that prescriptions (and their refills) will require a new prescription and prior authorization if the prescription life exceeds six months or the refill exceeds the 5 refill limit. The educational alert will state, "NEW RX WILL REQUIRE PA AFTER (DATE)."

The Medicaid PBM Program utilizes a numbering system to assist providers in maintaining the lists disseminated. You will note the list included with this correspondence is "03-04". Please be advised this attachment contains the current drug listings on the PDL and supersedes all previous lists issued.

Information on the Prior Authorization process, including the PDL and Prior Authorization Request Form (copy is attached, Form RXPA01), is also available on the Louisiana Medicaid website (www.lamedicaid.com). This website will be updated when changes (additions or deletions) are made to the PDL. The program may also utilize the provider remittance advices to notify providers of PDL changes that must be implemented in short time frames.

The Department has received inquiries that drug products requiring PA are not reimbursable by Medicaid. Medicaid does reimburse for drug products requiring prior authorization when the prior authorization process is followed.

Also, attached is Appendix D detailing the information required to review retroactive eligibility. Please be advised that pharmacy claims will only be overridden for the prior authorization edit for eligibles with certified retroactive eligibility. Claims submitted for eligibles who do not have retroactive eligibility will not have the PA edit overridden.

Thank you for your continued cooperation. We appreciate your participation in the Medicaid Program.

Sincerely,

Ben A. Bearden

Director

BAB/ht

Attachments (3)

The above letter and the Preferred Drug List are also available in PDF format on the Downloadable Forms and Files page.