Gov. Jeff Landry (R) starts his first term with a Republican supermajority in both houses. The Governor immediately convened an 8-day special session on January 15 to address three issues – congressional redistricting, reconfiguring the Supreme Court and changing the elections system. 

Also in Louisiana, the Department of Health announced that effective February 1, the clotting factor reimbursement methodology will change to an average acquisition cost per unit and a dispensing fee per unit dispensed and will be limited to pharmacy claims only. 

Finally in Louisiana, the Board of Pharmacy’s Regulatory Project 2023-02 ~ Temporary Closure of Pharmacy Final Rule went into effect on January 20. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Board of Pharmacy’s Regulation Review Committee has posted the agenda for the January 24 meeting in Baton Rouge.  

Also in Louisiana, the Department of Health’s (LDH’s) vendor Magellan will approve overrides for non-preferred products when the preferred product has a manufacturer shortage. Contact the Magellan Medicaid Administration help desk at (800) 424-1664 to get the override. The prescriber does not need to fill out a prior authorization. The current list of drugs with known shortages are Sabril® 500mg powder for oral solution, generic Concerta®, generic Focalin XR®, Trileptal® suspension and generic Mydayis™. 

Finally in Louisiana, LDH (Department of Health) issued Bulletin 24-1 informing providers that Medicaid is updating the Medicaid Fee-For-Service (FFS) files procedure codes.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

On January 7, Gov. Jeff Landry (R) was sworn into office, replacing former Gov. John Bel Edwards (D), who had reached his term limit. Ralph Abraham, MD, a physician, was appointed head of the Louisiana Department of Health. NACDS and our in-state partner, the Louisiana Alliance for Retail Pharmacies (LARP), have requested a meeting. 

Also in Louisiana, the new Legislature elected last Fall was sworn in on January 8. Currently, Republicans hold a supermajority in both Houses. 

Also in Louisiana, NACDS’ in-state partner, the Louisiana Alliance of Retail Pharmacies (LARP), submitted a comment letter to the Board of Pharmacy at the December 28, 2023, public hearing raising concerns about a proposed rule on product integrity that implements temperature control measures for shipments of prescription drugs to patients. Specifically, the proposed rule change would require ALL home delivery medications, including room temperature medications, to be sent in temperature-controlled packaging from pharmacies to patients.  

Also in Louisiana, the Department of Health (LDH) issued an Informational Bulletin 23-22 to Medicaid providers reminding them that RSV vaccines that have been covered since August 3, 2023, must have the correct CPT codes 90380 and 90381.  

Finally in Louisiana, in late December 2023, the Centers for Medicare & Medicaid Services (CMS) approved the state plan amendment (SPA) to increase the dispensing fee for local pharmacies only from $10.99 to $11.81. The increased fee applies to Medicaid Fee-for-Service pharmacy claims and Medicaid Managed Care local pharmacy claims, retroactive to the date of service of October 1, 2023. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health issued an informational bulletin on tobacco cessation counseling. 

Also in Louisiana, the Department of Health (LDH) updated the available options to providers for pursuing resolution of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service (FFS) claims processor, Gainwell Technologies. Unless explicitly notated, providers should first seek resolution with the MCO or Gainwell directly, prior to engaging LDH or other third parties. 

Finally in Louisiana, the Board of Pharmacy is soliciting comments and holding a Public Hearing on December 28 on three proposed rule changes: 

1. Regulatory Project 2023-09 ~ Product Integrity – (temperature control for mail order) 
2. Regulatory Project 2023-10 ~ Prescription Monitoring Program (PMP)  
3. Regulatory Project 2023-11 ~ Pharmacists Application 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health (LDH) issued a report detailing the results of key initiatives and policy goals for five major categories designed to make measurable improvements:

• Improve health and well-being across the lifespan of Louisianans
• Support vulnerable and underserved populations
• Invest in and empower #TeamLDH
• Improve performance, accountability, and compliance
• Strengthen customer service, partnerships, and community relations

Also in Louisiana, LDH issued a bulletin outlining the available options to providers for pursuing claims resolutions and appeals of issues with Medicaid managed care organizations (MCO) and the state’s fee-for-service claims processor, Gainwell Technologies.

Also in Louisiana, LDH issued a revised bulletin with added information on provider enrollment.

Also in Louisiana, LDH announced an 11% decline in new human immunodeficiency virus (HIV) diagnoses over the past five years. As of June 2023, the number of individuals living with HIV in Louisiana stands at 22,920.

Finally in Louisiana, LDH issued a memorandum announcing that diabetic supplies will be added to the Medicaid Single Preferred Drug List to be reimbursed as pharmacy claims only effective December 1, 2023.

For more information, contact NACDS’ Mary Staples at 817-442-1155.

November 18 is the date for runoff election for those statewide and state legislative races. Chain pharmacies are closely watching State Rep. Barbara Frieberg (R) race in Baton Rouge, as she was our champion that fought for the immunizations bill that died in the last two hours of the legislative session that would have made the federal PREP (Public Readiness and Emergency Preparedness) Act efficiencies permanent. 

Also in Louisiana, if the Louisiana Legislature wants to prevent a district court from changing its congressional map, it has until January 15 to produce a new redistricting plan, the 5th Circuit Court of Appeals ruled on November 10. 

Also in Louisiana, the Board of Pharmacy’s quarterly meeting was on November 15 in Baton Rouge. 

Also in Louisiana, Medicaid announced that by the end of the year there will be a new Naloxone Standing Order signed by Dr. Shantel Hebert-Magee, the state’s new Medicaid Chief Medical Officer, once Dr. James Hussey retires. Pharmacies need to take note for 2024 billing purposes. 

Finally in Louisiana, the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCO) managed by Magellan, was finally implemented on October 28. Magellan Medicaid Administration Inc. is now processing Medicaid MCO (managed care organization) pharmacy claims for all six MCOs (Managed Care Organizations) (Aetna Better Health, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare Community Plan). The Magellan Medicaid Administration portal is live with helpful information.  

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The Department of Health (LDH (Louisiana Department of Health)) Medicaid posted several new provider notices. 

• Louisiana Medicaid Pharmacy Diabetic Supplies on the Preferred Drug List (PDL) for Outpatient Pharmacy Services – Effective October 28, 2023 
• Louisiana Medicaid Pharmacy Counseling for Vaccines – Implementation Postponed to October 28, 2023 
• Louisiana Medicaid Pharmacy COVID-19 Vaccines 2023-2024 Update 
• Louisiana Medicaid Pharmacy Maintenance Medications Professional Dispensing Fee for Managed Care Organizations (MCOs) – Implementation Postponed to October 28, 2023 

 Also in Louisiana, the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCO) original implementation of October 1 was postponed until October 28, 2023. Magellan Medicaid Administration Inc. will serve as the processor for all Medicaid MCO pharmacy for all six MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and United Healthcare). Currently Magellan is only processing test claims. If you would like to submit test claims, please e-mail RxPharmacyTesting@magellanhealth.com your contact’s name, phone number, pharmacy National Provider Identifier and Switch information to receive the testing packet. 

Finally in Louisiana, two-term Attorney General Jeff Landry (R) triumphed in the Louisiana governor’s race in a crowded field with more than a dozen candidates. Landry flipped the seat to the GOP, receiving over 51% of the vote last Saturday in the state’s so-called “jungle primary” election where all the candidates in both parties are on the same ballot. Gov. John Bel Edwards (D) was termed limited and could not seek election to a third term. For those state legislative and statewide office races where no one received more 50% of the vote, the top two contenders will face off in the November 18 general election. 

For more information, contact NACDS’ Mary Staples at 817-442-1155.

Effective October 1, 2023, the Department of Health (LHD) is increasing the professional dispensing fee (PDF) $0.82 to $11.81 for local pharmacies only for all Medicaid Fee-for-Service (FFS) and Managed Care Organization (MCO)claims. The current PDF is $10.99.

Also in Louisiana, the Department of Health (LDH) Bureau of Health Services Financing’s Interim Medicaid Executive Director Kimberly Sullivan announced the new implementation date for the Single Pharmacy Benefits Manager (PBM) for Managed Care Organizations (MCOs) is now October 28, 2023. Magellan Medicaid Administration Inc. will serve as the single PBM processor for all six MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and United Healthcare).

Also in Louisiana, the Board published five final rules in the September 20, 2023, edition of the Louisiana Register, with immediate effective dates.

• Regulatory Project 2023-03 – Pharmacy Benefit Managers
• Regulatory Project 2023-04 – Healthcare Workplace Violence Prevention
• Regulatory Project 2023-05 – Pharmacy Change of Ownership
• Regulatory Project 2023-06 – Staffing Ratios
• Regulatory Project 2023-08 – DATA-Waiver Registration Elimination

Finally in Louisiana, the Department of Health (LDH) Medicaid issued several documents detailing changes also effective October 1:

• Louisiana Medicaid Pharmacy Maintenance Medications Professional Dispensing Fee for Managed Care Organizations (MCOs) – Effective October 1, 2023
• Louisiana Medicaid Pharmacy Single Pharmacy Benefits Manager (PBM) for Medicaid Managed Care – Effective October 1, 2023
• Louisiana Medicaid Pharmacy Clotting Factor Products Update – Effective October 1, 2023
• Louisiana Medicaid Pharmacy Counseling for Vaccines – Effective October 1, 2023

For more information, contact NACDS’ Mary Staples at 817-442-1155.

The new Single Pharmacy Benefits Manager (PBM) for Medicaid Managed Care will start on October 1, 2023. Magellan Medicaid Administration (MMA) will process all Medicaid managed care organization (MCO) pharmacy claims.   

• A new Department of Health (LDH (Louisiana Department of Health)) Pharmacy portal still under construction website will go live on October 1, 2023.   
• Pharmacy processing information for all six Medicaid MCOs (Managed Care Organizations) starting October 1, 2023:  

• BIN Number: 025986   
• NCPDP (National Council for Prescription Drug Programs) Version/Release #: D.0   
• Processor Control #: 1214172240 
• Group ID: LAMCOPBM   
• Magellan Rx Management Pharmacy Call Center is available 24 hours a day, seven days a week, 365 days a year. 
• The Member and Pharmacy Help Desk Phone Number is 1-800-424-1664  
• Pharmacy Prior Authorizations (PA) phone number: 1-800-424-1664   
• Fax Number: 1-800-424-7402  
• Electronic: Enter prescriber PA at www.covermymeds.com 
• MRx encourages pharmacies to submit test claims prior to the transition during the testing window from August 28, 2023, through September 15, 2023. To participate, you will need to e-mail MRxPharmacyTesting@magellanhealth.com with your name, phone number, pharmacy National Provider Identifier, and Switch information to receive the testing packet.  

Also in Louisiana, state elections will be held this fall. The Primary will be held on October 14, and the General election will be on November 18. Tim Temple (R) is now running unopposed for Insurance Commissioner now that political newcomer Rich Weaver, dropped out of that race.  

Also in Louisiana, starting on October 1, LDH will reimburse pharmacies for glucose monitors and diabetics supplies, and add diabetic supplies to the Medicaid Single Preferred Drug List to have one list of preferred/non-preferred products. As of December 1, 2023, diabetic supplies will be limited to pharmacy claims only.  

Also in Louisiana, the next scheduled meeting of the Council on Medicaid Pharmacy Reimbursement is on September 13.  

Also in Louisiana, Kimberly Sullivan is the new Interim Executive Medicaid Director for the Louisiana Department of Health (LDH), replacing Tara LeBlanc. 

Finally in Louisiana, LDH provided several updates for pharmacies.  

• Louisiana Medicaid Pharmacy Maintenance Medications Professional Dispensing Fee for Managed Care Organizations (MCOs) – Effective October 1, 2023 
• Louisiana Medicaid Pharmacy Single Pharmacy Benefits Manager (PBM) for Medicaid Managed Care – Effective October 1, 2023 
• Louisiana Medicaid Pharmacy Clotting Factor Products Update – Effective October 1, 2023 
• Louisiana Medicaid Pharmacy Counseling for Vaccines – Effective October 1, 2023 

For more information, contact NACDS’ Mary Staples at 817-442-1155.