Current through Register Vol. 50, No. 9, September 20, 2024
A. The
medication must be prescribed by a practitioner who is authorized to prescribe
under state law. The national drug code (NDC) must be identified on each
pharmacy claim for reimbursement. Prescription drugs considered for payment are
subject to rebates from manufacturers as mandated by federal law and
regulations.
B. Covered Drugs.
Coverage of drugs shall be limited to specific drug products authorized for
reimbursement by therapeutic category and listed by generic name,
strength/unit, NDC, and brand name. Those drug products subject to mandatory
coverage as a result of a rebate agreement with the federal government will be
covered until written notice is received from the Centers for Medicare and
Medicaid Services that coverage will be terminated. Providers will be given
notice of termination of coverage.
C. Prior Authorization with a Preferred Drug
List
1. A prior authorization process is
established which utilizes a preferred drug list (PDL) for selected therapeutic
classes. Drugs in selected therapeutic classes that are not included on the PDL
shall require prescribers to obtain prior authorization. Lists of covered drug
products, including those that require prior authorization, will be maintained
on the Louisiana Medicaid web site.
2. The prior authorization process provides
for a turnaround response by either telephone or other telecommunications
device within 24 hours of receipt of a prior authorization request. In
emergency situations, providers may dispense at least a 72-hour supply of
medication.
3. The Pharmaceutical
and Therapeutics Committee will make recommendations to the Department
regarding drugs to be considered for prior authorization. The composition of
and appointment to the Pharmaceutical and Therapeutics Committee complies with
R.S.
46:153.3(D) and 42
U.S.C.s1396r-8.
D.Drugs
Excluded from Coverage. As provided by §1927(d)(2) of the Social Security Act,
the following drugs are excluded from program coverage:
1. select agents when used for anorexia,
weight loss, or weight gain, except Orlistat (Xenical);
2. select agents when used to promote
fertility, except vaginal progesterone when used for high-risk pregnancy to
prevent premature births;
3. select
agents when used for symptomatic relief of cough and cold, except prescription
antihistamine and antihistamine/decongestant combination products;
1. select covered outpatient drugs when used
for anorexia, weight loss, or weight gain as determined by the
department;
2. select covered
outpatient drugs when used to promote fertility as determined by the
department;
3. select covered
outpatient drugs when used for symptomatic relief of cough and cold as
determined by the department;
4.
select prescription vitamin and mineral covered outpatient drugs as determined
by the department; and
a. - o.
Repealed.
5. select
over-the-counter covered outpatient drugs as determined by the
department.
E. Otherwise
Restricted Drugs
1. The state will cover
agents when used for cosmetic purposes or hair growth only when the state has
determined that use to be medically necessary.
2. Select drugs for erectile dysfunction,
except when used for the treatment of conditions, or indications approved by
the FDA, other than erectile dysfunction.
AUTHORITY NOTE:
Promulgated in accordance with
R.S.
36:254, Title XIX of the Social Security Act,
and the 1995-96 General Appropriate Act.
