RA Messages for May 5, 2009
PHARMACY PROVIDERS, PLEASE
NOTE!!!
If you are unsure about the coverage of a drug
product, please contact the PBM help desk at 1-800-648-0790.
Please note the
following changes to Appendix A
DRUG
DOSE
STRG
LMAC
EFF.
ALBUTEROL SULFATE
VIAL-NEB
2.5MG/0.5ML
OFF MAC
04/21/09
BETAMETHASONE DIPROPIONATE
POWDER
OFF MAC
04/21/09
BUPIVACAINE HCL
POWDER
100
OFF MAC
04/21/09
CAPTOPRIL/HCTZ
TABLET
50M-15MG
OFF MAC
04/21/09
CEFOXITIN SODIUM
VIAL
10G
OFF MAC
04/21/09
CEFUROXIME SODIUM
VIAL 25ML
750MG
OFF MAC
04/21/09
CEFUROXIME SODIUM
VIAL 1ML
750MG
OFF MAC
04/21/09
CHLORTHALIDONE
TABLET
25MG
OFF MAC
04/21/09
COCAINE
HCL
SOLUTION
10%
OFF MAC
04/21/09
COCAINE
HCL
SOLUTION
4%
OFF MAC
04/21/09
CROMOLYN
SODIUM
POWDER
OFF MAC
04/21/09
CYCLOBENZAPRINE HCL
POWDER
100%
OFF MAC
04/21/09
DEXAMETHASONE
TABLET
0.5MG
OFF MAC
04/21/09
DEXAMETHASONE SOD PHOS/PF
VIAL
10MG/ML
OFF MAC
04/21/09
DEXCHLORPHENIRAMINE MALEATE
TAB SA
6MG
OFF MAC
04/21/09
DIAZEPAM
VIAL
5MG/ML
OFF MAC
04/21/09
DOPAMINE
HCL/DEXTROSE 5%
INFUS BTL
800MG/0.5L
OFF MAC
04/21/09
DOXEPINE
HCL
ORAL CONC
10MG/ML
OFF MAC
04/21/09
FE
BISGLY/FE PS CMPLX/VIT
C CAPSULE
150-50MG
OFF MAC
04/21/09
FERROUS
SULFATE/VIT C/FA
TABLET SA
105-500-.8
OFF MAC
04/21/09
FLUOCINOLONE ACETONIDE
CREAM 60GM
0.025%
OFF MAC
04/21/09
FLUOCINOLONE ACETONIDE
CREAM 15GM
0.025%
OFF MAC
04/21/09
FLUPHENAZINE DECANOATE
VIAL
25MG/ML OFF
MAC
04/21/09
FOLIC
ACID/MULTIVITS-MIN
TABLET
1MG
OFF MAC
04/21/09
GUAIFENESIN/P-EPHED HCL
TAB SR 12H
600MG-120MG OFF MAC
04/21/09
GUAIFENESIN/P-EPHED HCL
TAB SR 12H
700-80MG OFF
MAC
04/21/09
GUAIFENESIN/P-EPHED HCL
TAB SR 12H
795MG-85MG OFF
MAC
04/21/09
GUAIFENESIN/P-EPHED HCL
TAB SR 12H
800-45MG OFF
MAC
04/21/09
GUAIFENESIN/P-EPHED HCL
TAB SR 12H
800MG-60MG OFF MAC
04/21/09
GUAIFENESIN/PHENYLEPHRINE
TAB SR 12H
275-25MG OFF MAC
04/21/09
GUAIFENESIN/PHENYLEPHRINE
TAB SR 12H
600MG-20MG OFF MAC
04/21/09
HOMATROPINE HBR
DROPS
5% OFF MAC
04/21/09
HYDROCORTISONE
LOTION
1% OFF MAC
04/21/09
HYOSCYAMINE SULFATE
CAP SR 12H
0.375MG OFF MAC
04/21/09
IMMUNE
GLOBULIN,GAMMA(IGG)
VIAL
5G OFF MAC
04/21/09
IPRATROPIUM BROMIDE
POWDER
OFF MAC
04/21/09
ISONIAZID
TABLET
100MG OFF MAC
04/21/09
KETOPROFEN
CAP24H PEL
200MG OFF MAC
04/21/09
KETOROLAC TROMETHAMINE
CARTRIDGE
15MG/ML OFF MAC
04/21/09
LEVOBUNOLOL HCL
DROPS
0.25% OFF MAC
04/21/09
METHYLPREDNISOLONE SOD SUCC VIAL
125MG/2ML OFF MAC
04/21/09
METHYLTESTOSTERONE
POWDER 5GM
OFF MAC 04/21/09
METHYLTESTOSTERONE
POWDER 25GM
OFF MAC 04/21/09
METOPROL/HCTZ
TABLET
100-50MG OFF MAC
04/21/09
MEXILETINE HCL
CAPSULE
150MG OFF MAC
04/21/09
MEXILETINE HCL
CAPSULE
200MG OFF MAC
04/21/09
MEXILETINE HCL
CAPSULE
250MG OFF MAC
04/21/09
MIDAZOLAM HCL
DISP SYRIN
5MG/ML OFF MAC
04/21/09
MORPHINE
SULFATE
POWDER
100% OFF MAC
04/21/09
NAFCILLIN SODIUM
VIAL PORT
1G OFF MAC
04/21/09
NEOMYCIN
SULFATE
POWDER 100GM
OFF MAC 04/21/09
NEOMYCIN
SULFATE
POWDER 10GM
OFF MAC 04/21/09
NEOSTIGMINE METHYLSULFATE
VIAL
1:2000 OFF
MAC 04/21/09
NITROGLYCERIN
CAPSULE SA
9MG OFF MAC
04/21/09
P-EPHED
HCL/BROMPHENIRAMINE CAPSULE SA
60-6MG OFF MAC
04/21/09
P-EPHED
SUL/LORATADINE
TAB SR 12H
OFF MAC 04/21/09
PERGOLIDE MESYLATE
TABLET
1MG OFF MAC
04/21/09
PERGOLIDE MESYLATE
TABLET
0.25MG OFF MAC
04/21/09
PHENOBARBITAL
VIAL
125MG/2ML OFF MAC
04/21/09
PHENYLEPHRINE HCL
VIAL
10MG/ML OFF MAC
04/21/09
PHENYLEPHRINE/CHLOR-MAL/SCOP SOLUTION
10-2-1.25 OFF MAC
04/21/09
PHENYLEPHRINE/PYRIL TAN/CP
ORAL SUSP
5-12.5-2/5 OFF MAC
04/21/09
PNV W-O
CA NO3/FE FUMARATE/FA CAPSULE
106MG-1MG OFF MAC
04/21/09
PRENATAL
VIT/FE FUMARATE/FA
TABLET
29MG-1MG OFF MAC
04/21/09
PROCAINAMIDE HCL
CAPSULE
250MG OFF MAC
04/21/09
PROPRANOLOL HCL
VIAL
1MG/ML OFF MAC
04/21/09
PROPRANOLOL/HCTZ
TABLET
80-25MG OFF MAC
04/21/09
PSEUDOEPHE TAN/DEXCHLOR TAN ORAL SUSP
75-2.5MG/5 OFF MAC
04/21/09
PSEUDOEPHEDRINE HCL/CHLOR-MAL
CAP SR 12H
60MG-4MG OFF MAC
04/21/09
PSEUDOEPHEDRINE/CPM/METHSCOPOL TAB SR 12H
90-8-2.5 OFF MAC
04/21/09
SELEGILINE HCL
TABLET
5MG OFF MAC
04/21/09
SELEGILINE HCL
CAPSULE
5MG OFF MAC
04/21/09
SODIUM
FLUORIDE
DROPS
0.5MG/ML OFF MAC
04/21/09
TETRACAINE HCL
DROPS
0.5% OFF MAC
04/21/09
THEOPHYLLINE ANHYDROUS
CAP SR 12H
300MG OFF MAC
04/21/09
HYOSCYAMINE SULFATE
TAB SR 12H
0.375MG 1.31843
04/28/09
Please file
adjustments for claims that may have been incorrectly paid. Only those
products of the manufacturers which participate in the Federal Rebate
Program will be covered by the Medicaid program. Participation may be
verified in Appendix C, available at
www.lamedicaid.com.
ATTENTION
PROVIDERS
For
Medicaid pharmacy services effective May 1, 2009, the Department of
Health and Hospitals, Bureau of Health Services Financing will establish
a five-prescription limit per recipient per calendar month. Please refer
to www.lamedicaid.com for detailed information.
ATTENTION
PROVIDERS: CHANGES IN TRANSMITTING COMMUNITYCARE PCP
REFERRAL AUTHORIZATION NUMBERS FOR EDI CLAIMS
Effective with date of
processing June 1, 2009, service providers will be required to transmit
the PCP's 10-digit NPI as the CommunityCARE Referral Authorization
Number on EDI claims transactions. A detailed provider notice,
containing important information for both PCPs and servicing providers
that must have a referral, is posted on the homepage of the LA Medicaid
website, www.lamedicaid.com. Please visit the website to obtain this
needed information in order to make all necessary changes and be
prepared for this transition to avoid unnecessary claim denials.
ATTENTION
PHARMACY PROVIDERS
Updates
to the Pharmacy Benefits Management Services Manual are now available on
the Louisiana Medicaid website at www.lamedicaid.com. Pharmacy providers
should refer to the manual for a complete description of Medicaid
pharmacy program policy.