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 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
http://www.lamedicaid.com.
Should you have any questions
regarding any of the following messages, please contact Molina Medicaid
Solutions at (800) 473-2783 or (225) 924-5040.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Effective July 10, 2017, Fee-for-Service (FFS) pharmacy claims for opioid prescription products exceeding 120 MME (Morphine Milligram Equivalent) will deny at Point of Sale (POS). Prescribers can apply for an override of the denial by faxing an Opioid Analgesic Treatment Worksheet to 1-866-797-2329. Also, short-acting opiate prescription claims will be subject to a 7 day quantity limit for opioid naïve recipients. Please refer to www.lamedicaid.com for more information.
Attention Fee for Service (FFS) Louisiana Medicaid Providers:
Effective June 27, 2017, Fee-for-Service (FFS) Medicaid pharmacy claims will have the following clinical edits at Point of Sale (POS). Prescriptions for triptans will require an ICD-10-CM diagnosis code submitted in NCPDP field 424-DO (Diagnosis Code) for recipients less than 18 years old. Prescriptions for olmesartan/amlodipine/hydrochlorothiazide (Tribenzor®) and amlodipine/valsartan/hydrochlorothiazide (Exforge HCT®) will require prior drug use of two select antihypertensive drug therapies. Please refer to www.lamedicaid.com for more information.