RA Messages for July 6, 1999
ATTENTION: PHARMACY PROVIDERS
IN ACCORDANCE WITH THE FISCAL YEAR 1999-2000 GENERAL APPROPRIATION ACT,
THE DEPARTMENT OF HEALTH AND HOSPITALS WILL CHANGE ESTIMATED ACQUISITION
COST REIMBURSEMENT FOR PRESCRIPTION DRUGS TO:
AVERAGE WHOLESALE PRICE(AWP) MINUS 13.5% FOR ALL SINGLE SOURCE DRUGS
(BRAND NAME), MULTIPLE SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM
ALLOWABLE COST OR FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH
ARE SUBJECT TO MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION
THAT A BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR
RECIPIENT FOR CHAIN PHARMACIES ONLY. CHAIN PHARMACIES ARE DEFINED AS
FIVE OR MORE MEDICAID ENROLLED PHARMACIES UNDER COMMON OWNERSHIP.
THIS REIMBURSEMENT CHANGE IS EFFECTIVE FOR SERVICES BEGINNING JULY 1,
1999.
ALL OTHER MEDICAID-ENROLLED PHARMACIES ARE DEFINED AS INDEPENDENT AND
WILL REMAIN AT THE ESTIMATED ACQUISITION COST REIMBURSEMENT OF AWP
MINUS 10.5%
EFFECTIVE FOR DATES OF SERVICE BEGINNING JULY 1,1999, LOUISIANA MED-
ICAID WILL LIMIT PAYMENTS FOR PRESCRIPTION DRUGS TO THE LOWER OF:
* ESTIMATED ACQUISITION COST WHICH IS DEFINED AS AVERAGE WHOLESALE
PRICE MINUS 10.5% FOR INDEPENDENT PHARMACIES AND 13.5% FOR CHAIN
PHARMACIES, FOR ALL SINGLE SOURCE DRUGS (BRAND NAME), MULTIPLE
SOURCE DRUGS WHICH DO NOT HAVE A STATE MAXIMUM ALLOWABLE COST OR
FEDERAL UPPER LIMIT AND THOSE PRESCRIPTIONS WHICH ARE SUBJECT TO
MAC OVERRIDES BASED ON THE PHYSICIAN'S CERTIFICATION THAT A
BRAND NAME PRODUCT IS MEDICALLY NECESSARY FOR A PARTICULAR
RECIPIENT PLUS THE MAXIMUM ALLOWABLE OVERHEAD COST (DISPENSING
FEE).
* LOUISIANA MAXIMUM ALLOWABLE COST LIMITATION PLUS THE MAXIMUM
ALLOWABLE OVERHEAD COST:
* FEDERAL UPPER LIMIT PLUS THE MAXIMUM ALLOWABLE COST; OR
* PROVIDER'S USUAL AND CUSTOMARY CHARGE TO THE GENERAL PUBLIC.
***** 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 MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX A:
| Drug |
Dosage |
Strength |
MAC |
Eff.
Date |
| AHF,
HUman/VWF, HUMAN |
VIAL |
250-500U |
|
06/01/99 |
| AHF,
HUman/VWF, HUMAN |
VIAL |
1-2 MU |
|
06/01/99 |
| ALITRETINOIN |
GEL |
0.1% |
|
07/01/99 |
| AMOXIXILLIN TRIHYDRATE |
SUSP RECON |
200MG/5ML; 400MG/5ML |
|
06/19/99 |
| AMOXIXILLIN TRIHYDRATE |
TAB CHEW |
200MG; 400MG |
|
06/19/99 |
| CLONIDINE HCL |
TABLET |
0.1 MG |
0.10390 |
06/01/99 |
| CLONIDINE HCL |
TABLET |
0.2 MG |
0.09950 |
06/01/99 |
| CLONIDINE HCL |
TABLET |
0.3 MG |
0.12545 |
06/01/99 |
| CYPROHEPTADINE HCL |
SYRUP |
2MG/5 ML |
0.02130 |
06/01/99 |
| DENILEUKIN DIFTITOX |
VIAL |
150 MCG/ML |
|
07/01/99 |
| DOXEPIN HCL |
CAPSULE |
10 MG |
0.12950 |
06/01/99 |
| DOXEPIN HCL |
CAPSULE |
25 MG |
0.13250 |
06/01/99 |
| DOXEPIN HCL |
CAPSULE |
50 MG |
0.19100 |
06/01/99 |
| DOXEPIN HCL |
CAPSULE |
75 MG |
0.35750 |
06/01/99 |
| DOXEPIN HCL |
CAPSULE |
100 MG |
0.42050 |
06/01/99 |
| DOXEPIN HCL |
CAPSULE |
150 MG |
0.55500 |
06/01/99 |
| ISOSORBIDE DINITRATE |
TABLET |
30 MG |
0.04810 |
06/01/99 |
| ISOSORBIDE DINITRATE |
TABLET |
30 MG |
OFF MAC |
06/21/99 |
| MEPROBAMATE |
TABLET |
200MG |
0.05350 |
06/01/99 |
| MEPROBAMATE |
TABLET |
400MG |
0.09125 |
06/01/99 |
| MODAFINIL |
TABLET |
200MG |
|
04/01/99 |
| PROBENECID |
TABLET |
500MG |
0.16050 |
06/01/99 |
| PROPOXYPHENE
HCL |
CAPSULE |
65MG |
0.07350 |
06/01/99 |
| PROPRANOLOL HCL |
TABLET |
10MG |
0.05700 |
06/01/99 |
| PROPRANOLOL HCL |
TABLET |
20MG |
0.07850 |
06/01/99 |
| PROPRANOLOL HCL |
TABLET |
40MG |
0.12750 |
06/01/99 |
| PROPRANOLOL HCL |
TABLET |
60MG |
0.15300 |
06/01/99 |
| PROPRANOLOL HCL |
TABLET |
80MG |
0.18890 |
06/01/99 |
| ROFECOXIB |
ORAL SUS |
12.5MG/5ML;25MG/5ML |
|
05/21/99 |
| ROFECOXIB |
TAB |
12.5MG;25MG |
|
05/21/99 |
| ROSIGLITAZONE MALEATE |
TAB |
2MG;4MG |
|
06/01/99 |
| ROSIGLITAZONE MALEATE |
TAB |
8MG |
|
06/01/99 |
| SECOBARBITAL SODIUM |
ORAL CAP |
100MG |
OFF MAC |
06/07/99 |
PLEASE MAKE THE FOLLOWING CHANGES TO THE 8/15/98 VERSION OF APPENDIX B:
| LABELER |
COMPANY |
BEGIN |
END |
| 00217 |
DUNHALL PHARMACEUTICAL |
7/1/99 |
|
| 00392 |
CRANDALL ASSOCIATE,INCORPORATED |
|
7/1/99 |
| 10191 |
REMEDY MAKERS |
|
7/1/99 |
| 51641 |
ALRA LABORATORIES,INCORPORATED |
|
7/1/99 |
| 54162 |
GERITEX CORPORATION |
7/1/99 |
|
| 57685 |
ADVANCED REMEDIES,INCORPORATED |
|
7/1/99 |
| 61298 |
OPTIMUM PHARMACEUTICALS LLC |
|
7/1/99 |
| 61808 |
IMIREN PHARMACEUTICAL,INC |
10/1/99 |
|
| 61924 |
DERMARITE
INDUSTRIES(REINSTATED) |
7/1/99 |
|
| 62939 |
BRIGHTSTONE PHARMA,INCORPORATED |
|
7/1/99 |
| 64365 |
LIGAND PHARMACEUTICALS |
7/1/99 |
|
| 64731 |
INTEGRITY PHARMACEUTICAL CORPORATION |
7/1/99 |
|
| 64813 |
ALGOS
PHARMACEUTICAL CORPORATION |
7/1/99 |
|
| 79854 |
NATIONAL VITAMIN COMPANY |
|
7/1/99 |
PLEASE FILE ADJUSTMENTS FOR CLAIMS WHICH MAY HAVE BEEN INCORRECTLY PAID