LETTER TO PROVIDERS
June
14, 2004
Dear Pharmacy
Provider:
Attached is the complete,
most current listing of drugs on the Medicaid Prior Authorization (PA Process'
Preferred Drug List (PDL) "04-02." 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)."
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. Additionally,
should a claim deny because a PA is required, you may want to 1) verify that the
PA was actually obtained and the dates of service for the PA; 2) verify that the
filling date on the claim is subsequent to the start date of the PA. (Remember: PAs are not
retroactive); and 3) call the POS help desk at 1-800-648-0790 for further
assistance.
Please note that for drugs available over-the-counter
(OTC) shall not be billed to the Medicaid Program with the NDC for the legend
product. The OTC NDCs will not be
covered by the Department. NDCs of
the legend product that remain covered will be subject to PA and POS
requirements.
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
Medicaid 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.