Pharmacy

The Louisiana Department of Health pharmacy services are included as a benefit in managed care. Pharmacy services remain in legacy Medicaid for recipients not enrolled in managed care. Pharmacy provider relations support for legacy Medicaid is handled by the Medicaid fiscal intermediary, Gainwell Technologies.

Louisiana Medicaid Single Preferred Drug List (PDL)

• Louisiana Medicaid Single PDL – Fee for Service and Managed Care Organizations 
• Archived PDLs

Pharmacy Resources

• Act 292 of the 2022 Regular Legislative Session Council on Medicaid Pharmacy Reimbursement
• Submit Remittance Advice (RA) Request
• Louisiana Medicaid Pharmacy Copayments - Recipient Notice (Effective 1/1/2020)
• Louisiana Uniform Prescription Drug Prior Authorization (PA) Form and Fax Coversheet
• ICD-10-CM Diagnosis Code Policy Chart
  • Archived ICD-10-CM Diagnosis Code Policy Charts
• Maintenance Medications - Quarterly
  • Archive
• MEVS Help Guide
• Medicaid Pharmaceutical & Therapeutics Committee
• Pharmacy Benefits Manager Stakeholder Meeting Presentation
• Louisiana MCO Single PBM Implementation Project All Stakeholder Meeting

Pharmacy Facts

• Pharmacy Facts: Program Updates from Louisiana Medicaid

Pharmacy News

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

• Pharmacy Provider Notices
• Naloxone Standing Order
• Saving Lives with Naloxone: A Tool for Louisiana Pharmacists to Use for Naloxone Education
• Notice to Providers - Influenza Vaccine

Contacts 

Questions can be directed by plan as follows:

Aetna Better Health

• General Provider Issues - Call Provider Relations - 1-855-242-0802
• Pharmacy Contracting Issues - Call CVS Health - 1-855-364-2977
• Aetna Member with Issues - Have the Member Call Member Services - 1-855-242-0802
• Claims/Billing Issues - Call CVS Health - 1-855-364-2977
• Pharmacy Billing Information
  • BIN: 610591
  • PCN:ADV
  • Group: RX8834

AmeriHealth Caritas

• General Provider Issues - Call PerformRx Provider Relations - 1-800-684-5502
• Pharmacy Contracting Issues - Call PerformRx - 1-800-555-5690
• AmeriHealth Caritas Member with Issues - Have the Member Call Perform Rx Member Services - 1-866-452-1040
• Claims/Billing Issues - Call PerformRx - 1-800-684-5502
• Pharmacy Billing Information
  • BIN: 019595
  • PCN: 06030000

Healthy Blue

• General Provider Issues - Call Provider Relations - 1-844-521-6942
• Pharmacy Services
  • Pharmacy Contracting Issues - Call CVS - 1-866-488-4708
  • Member Pharmacy Services - 1-833-207-3114
  • Pharmacy provider help desk for claim processing - 1-833-236-6194
  • Pharmacy Billing Information
    • BIN: 020107
    • PCN: FG
    • Group: WKLA

Humana Healthy Horizons in Louisiana

• General Provider Issues - Call Provider Relations - 1-800-448-3810
• Pharmacy Contracting Issues - Call Gainwell Technologies –Provider Enrollment -  1-225-216-6370
• Humana Member with Issues - Have the Member Call LDH Pharmacy Help Desk - 1-800-437-9101
• Pharmacy Claims/Billing Issues - Call POS Help Desk - 1-800-648-0790 or 225-216-6381
• Pharmacy Billing Information
  • BIN: 610514 
  • PCN: LOUIPROD
  • Group: HUMANA

Louisiana Healthcare Connections

• General Provider Issues - Call Provider Relations - 1-866-595-8133
• Pharmacy Contracting Issues - CVS Caremark 1-800-311-0543
• Louisiana Healthcare Connections Member with Issues - Have the Member Call Member Services - 1-866-595-8133
• Claims/Billing Issues - Call CVS Caremark Pharmacy Help Desk – 1-800-311-0543
• Pharmacy Prior Authorization - Call Envolve Pharmacy Solutions - 1-888-929-3790 
• Pharmacy Billing Information 
  
  • BIN: 004336
  • RXPCN: MCAIDADV
  • RXGRP: RX5444
  • Member ID Format: 13 digit

United Healthcare Community Plan

• General Provider Issues - Call Provider Relations - 1-866-675-1607
• Pharmacy Contracting Issues - Call OptumRx - 1-877-633-4701
• Pharmacy Credentialing - Call OptumRx - 1-800-613-3591
• United Healthcare Member with Issues - Have the Member Call Member Services - 1-866-675-1607
• Claims/Billing Issues - Call OptumRx - 1-866-328-3108
• Pharmacy Billing Information
  • BIN: 610494
  • PCN: 9999
  • Group: ACULA

Fee For Service

• General Provider Issues - Call Provider Relations - 1-800-473-2783
• Pharmacy Contracting Issues - Call Gainwell Technologies Provider Enrollment - 1-225-216-6370
• Pharmacy Credentialing - Call Gainwell Technologies Provider Enrollment - 1-225-216-6370
• Pharmacy Claims/Billing Issues - Call POS Help Desk - 1-800-648-0790 or 225-216-6381
• Pharmacy Billing Information -  Call POS Help Desk - 1-800-648-0790 or 225-216-6381
• BIN: 610514 
• PCN: LOUIPROD
• Group: n/a
• Provider Enrollment Portal Issue -  Call: 1-833-641-2140 or email:  LouisianaProvEnroll@gainwelltechnologies.com

Any other pharmacy-related questions can be directed to the Medicaid Pharmacy Program at 1-800-437-9101. 

Providers can also submit questions by email to healthy@la.gov, and the appropriate staff will address any issues or concerns. Staff are typically able to respond within one business day.

Pharmacists and prescribing providers are strongly encouraged to review Informational Bulletins pertaining to the pharmacy integration.

RELATED INFO

• Archives

 

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