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.

For information regarding the medication policy and/or criteria associated with this denial, providers may access the Louisiana Medicaid Preferred Drug List (PDL) / Non-Preferred Drug List at http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf.

Attention Louisiana Medicaid Providers:

Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) updated the criteria for select drugs and therapeutic classes on the Louisiana Medicaid Single Preferred Drug List (PDL). Therapeutic classes/drugs with updated criteria include acne treatment agents, Orilissa®, Corlanor®, ergotamines, Endari®, GI antibiotics, Hepatitis C Direct-Acting Antiviral agents, anti-infectives, anticoagulants, antipsychotics, Behavioral Health agents, anxiolytics, Hereditary Angioedema (HAE) agents, Spravato®, cytokine and CAM Antagonists, incretin mimetics, sodium glucose co-transporter 2 (SGLT2) inhibitors, Kalydeco®, Substance Use Disorder (SUD) agents, and Calcitonin Gene-Related Peptide (CGRP) Antagonists. Please refer to http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf to access the document.

Attention Louisiana Medicaid Providers:

On August 5, 2019, Fee for Service (FFS) Medicaid updated their 340B billing policy. Reminder: only providers registered as 340B entities and listed on the HRSA Medicaid Exclusion File (MEF) may bill drug stock purchased through 340B to Medicaid. Please refer to lamedicaid.com under pharmacy and prescribing providers to access the document.

Attention Louisiana Medicaid Providers:

On August 1, 2019, Fee for Service (FFS) Medicaid and Managed Care Organizations (MCOs) implemented diagnosis code requirements at Point of Sale (POS) for progesterone (Crinone®) and tobramycin (Kitabis®). Please refer to http://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf to access the Single Preferred Drug List (P DL), which contains a complete listing of drugs with diagnosis code requirements at POS.