Pharmacy

Opioid Analgesic Treatment: Effective January 1st 2019, please submit requests for controlled substances using the new Uniform Prescription Drug Prior Authorization Form. Please review the pharmacy authorization guidelines to ensure you have submitted all guideline requirements.

Louisiana Uniform Prescription Drug Prior Authorization Form

The Louisiana Department of Health Resources

The Department would like to share our new “Opioid” web page. There are many great resources posted here:

http://ldh.la.gov/index.cfm/subhome/54

Don’t forget about the Naloxone Standing Order:

http://ldh.la.gov/assets/docs/BehavioralHealth/Opioids/Naloxonestandingorder.pdf

April 2017 Provider Update includes Morphine Equivalent Dose information:

http://www.lamedicaid.com/Providerupdate/provider_update_04_17.pdf
LDH Pharmacy Staff Communications: The Louisiana Department of Health would like to share their new “Opioid” web page. There are many great resources posted here

Delayed Long-term Care and Pharmacy Provider Payments Memo

Pharmacy Facts 07/24/20

FFS Pharmacy Adult Vaccine Billing

FFS and MCO Pharmacy Adult Vaccine Coverage

Pharmacy Facts 05/29/20

Pharmacy Facts 05/18/20 (Revised)

Pharmacy Facts 05/18/20

Pharmacy Facts 05/15/20

Louisiana Fee for Service (FFS) Medicaid Updated 340B Billing Policy - Effective August 5, 2019

Don’t forget about the Naloxone Standing Order:

http://ldh.la.gov/assets/docs/BehavioralHealth/Opioids/Naloxonestandingorder.pdf

April 2017 Provider Update includes Morphine Equivalent Dose information:

http://www.lamedicaid.com/Providerupdate/provider_update_04_17.pdf

Formulary drug list

The formulary is a list of drugs chosen by Louisiana Department of Health's Pharmacy P & T Committee and administered by Aetna Better Health of Louisiana. Drugs are listed as preferred and non-preferred. All non-preferred drugs are required to follow the prior authorization process.

There is a subset of drugs not listed on the Louisiana Medicaid Single PDL which may be available for coverage. These drugs typically do not require a prior authorization. Generic substitution is mandated by the state unless a drug is on the preferred drug list as a Brand Name product. Clinical edits, such as quantity limits and age restrictions, may apply to some drug categories.

Members must fill their prescriptions at an Aetna Better Health of Louisiana network pharmacy and follow other plan rules.

Please review the formulary for any restrictions or recommendations regarding prescription drugs before prescribing a medication to an Aetna Better Health of Louisiana patient.

Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations)

Mail order prescriptions

If your members take medicine for an ongoing health condition, they can have their medicines mailed to their home. Aetna Better Health works with a company called CVS Health to provide this service, at no cost to our members.

If they choose this option, their medicine comes right to their door. There are other benefits to home delivery:

Pharmacists check each order for safety.
Members can order refills by mail, by phone, online, or they can sign up for automatic refills.
Members can talk with pharmacists by phone at any time 24 hours a day, 7 days a week.

Members can sign up for this service in one of three ways. They can:

Call CVS Health toll-free at 1-855-271-6603 Monday to Friday between 8 a.m. and 8 p.m.,. CVS representatives will help your member sign up for home delivery. (As you are the provider, CVS will call you to get the prescription.)
Go to CVS website. Then, log in and sign up for ReadyFill. Again, CVS Health will contact you, the provider, to get a prescription.
Request a prescription from you for a 90-day supply with up to one year of refills. The member will then complete the mail- order services form and mail it to CVS Health along with the prescription.

CVS Health Mail Order Service Form English / Spanish

Over-the-counter drugs

Aetna Better Health of Louisiana also covers certain over-the-counter drugs if they are on our list. Some of these may have rules about how they can be covered. If the rules for that drug are met, we will cover the drug. Over-the-counter drugs must have a prescription for them to be covered at no cost to our members.

Pharmacy authorization guidelines

Effective May 1st, 2019, Aetna Better Health® of Louisiana adheres to the Healthy LA PDL clinical criteria to make decisions when you send in a request for a drug on the formulary/PDL that needs a review prior to being dispensed.

To access clinical criteria, click here to be taken to the Healthy LA Pharmacy clinical criteria.

Additional criteria found below will also apply as of May 1st, 2019.

Brand Name Medications

Compounds (effective 12.02.2019)

Diabetic Testing Supplies (effective 12.02.2019)

Quantity Level Limits

Hep C Subscription Model

Algorithms December 2019

Hep C LA Elimination Plan

Hep C Policy Criteria (Authorized Generic(AG) Epclusa Preferred)

State PDL Page 34 Hepatitis C Agents

Pharmacy prior authorization forms

To quickly find a prior authorization form, click CTRL F on your keyboard and type in the form name.

Louisiana Uniform Prescription Drug Prior Authorization Form

Hepatitis C DAA Request Form

Synagis

Electronic Prior Authorization (ePA)

We are committed to making sure our providers receive the best possible information, and the latest technology and tools available.

We have partnered with CoverMyMeds® and SureScripts to provide you a new way to request a pharmacy prior authorization through the implementation of Electronic Prior Authorization (ePA) program.

With Electronic Prior Authorization (ePA), you can look forward to:

Time saving

Decreasing paperwork, phone calls and faxes for requests for prior authorization

Quicker Determinations

Reduces average wait times, resolution often within minutes

Accommodating & Secure

HIPAA compliant via electronically submitted requests

No cost required! Let us help get you started!

Getting started is easy. Choose ways to enroll:

Visit the CoverMyMeds® website
Call CoverMyMeds® toll-free at 866-452-5017
Visit the SureScripts website
Call SureScripts toll-free at 866-797-3239

Billing Information:

BIN: 610591

PCN: ADV

Group: RX8834

Prescription Monitoring Program

The Prescription Monitoring Program (PMP) is accessed by utilizing the Louisiana Board of Pharmacy.

Specialty medications

CVS Health Specialty Pharmacy is a pharmacy that offers medications for a variety of conditions, such as cancer, hemophilia, immune deficiency, multiple sclerosis and rheumatoid arthritis. These specialty medications are not often available at local pharmacies. Specialty medications require service authorization before they can be filled and delivered. Providers can call 1-855-242-0802 to request prior authorization, or complete the applicable prior authorization form and fax to 1-844-699-2889.

Specialty medications can be delivered to the provider’s office, member’s home, or other location as requested.

Quantity Limits

Certain drugs on the formulary have quantity limits (QLLs). The QLLs are established based on FDA-approved dosing levels and nationally- established, recognized guidelines pertaining to the treatment and management of the condition being treated.

To request an override for the quantity limit, please fax the correct pharmacy Prior Authorization request form to 1-844-699-2889. You can include any medical records that will support your request.

Pharmacy & Therapeutics Committee