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Pharmacy PA guidelines
Pharmacy PA guidelines
When you request prior authorization (PA) for a drug on the PDL, we use the Healthy Louisiana PDL clinical criteria to make decisions.
Healthy Louisiana guidelines and policies
Healthy Louisiana pharmacy clinical criteria (PDF)
Choose the “Criteria” link under each drug class column and to the left of the drug column.
Diabetic test strips and lancets quantity limits: January 1, 2021 (PDF)
Aetna Better Health guidelines and policies
Compounds coverage policy/guideline: December 2, 2019 (PDF)
Electronic PA (ePA)
Electronic PA (ePA)
You need the right tools and technology to help our members. That’s why we’ve partnered with CoverMyMeds® and Surescripts to provide a new way to request a pharmacy PA with our ePA program.
With ePA, you can look forward to saving time with:
Less paperwork
Fewer phone calls and faxes
Quicker determinations
Safe and secure HIPAA-compliant submitted requests
Easy upload of clinical documents
Enroll now
Getting started with ePA is free and easy. You’ll need this info to enroll:
- BIN: 025986
- GRP: LAMCOPBM
- PCN: 1214172240
How to enroll
Other ways to request PA
If you don’t want to enroll in ePA, you can request PA:
Online
You can request PA through our secure Provider Portal.
Provider Portal
By phone
You can request PA by calling us at 1-855-242-0802 (TTY: 711).
By fax
Check “Request forms” in the next section to find the right form. Then, fax it with any supporting documentation for a medical necessity review to 1-844-699-2889.
Request forms
If you don’t see the right form in the list, you can use the uniform prescription drug PA form (PDF). Otherwise, check for the drug class or drug name that matches your needs:
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