Effective January 1, 2023, the Louisiana Medicaid Pharmacy Program expanded to include a sixth managed care organization (MCO), Humana Healthy Horizons. For more information on verifying eligibility and processing claims, go to Pharmacy Facts. 

Also in Louisiana, effective January 1, 2023, Medicaid Fee-for-Service (FFS) Pharmacy Program and Managed Care Organizations (MCOs), will implement a point of sale dispensing of contraceptives allowing a 6-month supply when the recipient has a previous history of contraceptive agents. The allowance applies to pharmacy claims submitted to FFS and MCOs (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare). 

Finally in Louisiana, the 2023 Naloxone standing order was updated effective January 1, 2023 

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

The Department of Health issued a Medicaid Bulletin 22-38 with updates and requirements for the provider enrollment portal.  

Also in Louisiana, Medicaid expanded its "Shot per 100,000" COVID-19 vaccine incentive program to include booster shots. Those age 5 years and older who received their first or second dose of the vaccine on or after April 5, 2022, qualify for this incentive, as do those age 6 months to age 4 years who were vaccinated with their first or second dose on or after July 5, 2022 and those age 6 months and older who received a vaccine booster dose on or after October 1, 2022, are all eligible for the $200 gift card. 

Also in Louisiana, the new Preferred Drug List (PDL) update will be implemented January 1, 2023. There were no new therapeutic classes added to the PDL during the Fall 2022 Pharmaceutical & Therapeutics (P&T) Committee review. 

Finally in Louisiana, Medicaid will include six health plans beginning January 1, 2023. They are Aetna Better Health, AmeriHealth Caritas, Healthy Blue Louisiana, Humana Healthy Horizons, Louisiana Healthcare Connections and UnitedHealthcare. Prior to January 1, 2023, most Medicaid members were auto-assigned to one of the Medicaid health plans. Attached is a communications toolkit. 

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

The Board of Pharmacy held their quarterly meeting on November 17.  

Also in Louisiana, Medicaid announced that another Managed Care Organization (MCO), Humana Healthy Horizons, will be added effective January 1, 2023, offering services to Medicaid recipients. The Medicaid Pharmacy Program will now consist of Medicaid Fee-for-Service (FFS) and six managed care organizations (Aetna, AmeriHealth Caritas, Healthy Blue, Humana Healthy Horizons, Louisiana Healthcare Connections, and UnitedHealthcare).  

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

The Board of Pharmacy quarterly meeting is scheduled on November 15 and 16 at the Board's office in Baton Rouge. Prior to the meeting, the agenda and public meeting binder will be accessible here. 

Also in Louisiana, Gov. John Bel Edwards (D) appointed 5 members to the 17-member Board of Pharmacy.  

• Ricky Indovina, pharmacist with Ochsner Health System to a third six-year term; 
• Raymond Strong, PharmD, with Ascension DePaul Services to a second six-year term; 
• Pharmacist Jennifer Elliott Dupree with Walmart, a new member to a six-year term; 
• Richard Mannino, independent pharmacy owner to a second six-year term and 
• Chris Melancon, a new independent staff pharmacist to a six-year term. 

Finally in Louisiana, on October 19th, the Medicaid Fee for Service (FFS) Pharmacy Program announced the implementation of an electronic drug prior authorization application to achieve a more streamlined authorization process. 

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

Gov. John Bel Edwards (D) appointed several members to serve on the Board of Pharmacy — independent pharmacist Richard Mannino and Walmart pharmacist Jennifer Dupree.

Also in Louisiana, Medicaid continues to enroll providers who have missed the September 30, 2022, deadline.

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

The Department of Health (LDH) Medicaid Pharmacy Program issued the following updates:

• Louisiana Medicaid Pharmacy Point of Sale Clinical Authorization and Updates for Select Medications – Effective October 1, 2022
• Louisiana Medicaid Pharmacy Point of Sale (POS) Edits – Effective October 1, 2022
• Louisiana Medicaid Pharmacy Point of Sale Quantity Limits – Effective October 1, 2022
• Louisiana Medicaid Pharmacy Point of Sale (POS) Diagnosis Code – Effective October 1, 2022
• Louisiana Medicaid Pharmacy Point of Sale (POS) Edits for Tramadol/Celecoxib (Seglentis®) – Effective October 1, 2022

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

The Board of Pharmacy Regulation Revisions Committee will be meeting on October 11 at their office in Baton Rouge to discuss these regulatory proposals.  

Also in Louisiana, the Department of Insurance Office of the Commissioner promulgated Regulation 122 defining the roles and responsibilities solely within the purview of pharmacy benefit managers and pharmacy services administrative organizations. 

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

The Department of Health’s (LDH) deadline for Medicaid providers to submit an enrollment application is September 20, 2022. Claims will be denied beginning December 31, 2022, for providers who have not completed the enrollment process by September 30. Providers should visit www.lamedicaid.com to enroll. Additional guidance is located at www.ldh.la.gov/medicaidproviderenrollment. Providers can also email questions to LouisianaProvEnroll@gainwelltechnologies.com or call 833-641-2140.

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

The Department of Health (LDH (Louisiana, the Department of Health)) Medicaid Pharmacy Facts includes detailed information on Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) coverage and reimbursements for flu and COVID booster. 

• Effective September 15, 2022, enrolled pharmacies will be reimbursed for the influenza vaccines and administration of the vaccines when given to Medicaid recipients, who are 19 years of age and older when the administering pharmacist is an enrolled Medicaid provider. The cost of the vaccine will not be reimbursed for recipients under the age of 19, only the administration fee will be reimbursed, as these vaccines are available through the Louisiana Vaccines for Children (VFC) program. The Louisiana Board of Pharmacy rules and regulations allow a vaccinating pharmacist to administer the influenza vaccine to individuals seven years of age and older. 
•  On September 23, 2022, with an effective date of August 31, 2022, the Louisiana Medicaid's Fee-for-Service (FFS) Pharmacy Program and the managed care organizations (MCO) are covering the bivalent COVID-19 vaccine booster, with Emergency Use Authorization (EUA). The federal government covers the cost of the COVID-19 vaccine. Therefore, Louisiana Medicaid will reimburse enrolled pharmacies the administration fee only. Coverage for the Pfizer, Janssen (Johnson & Johnson), and Moderna COVID-19 primary vaccine series will continue. 
• Louisiana Medicaid is hosting a series of provider webinars regarding the upcoming Provider Enrollment deadline. 

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