Pharmacy

Prescription Drugs and Over-the-Counter (OTC) Drugs

Louisiana Healthcare Connections covers many prescription drugs and over-the-counter drugs when prescribed by an in-network provider and filled by an in-network pharmacy. Your pharmacy benefit does not cover all medicines. Some require prior authorization. Some drugs have limitations on age, dosage or quantity. These limits make sure your medicines are safe and effective.

Some OTC medicines are covered if your doctor writes you a prescription. If you need an OTC medicine that is not covered, you will likely have to pay for it out of pocket. If you need a covered OTC medicine but don’t have a prescription, you will likely have to pay for it out of pocket.

Diabetic Supplies

Louisiana Healthcare Connections covers some diabetic supplies when prescribed by an in-network provider and filled by an in-network pharmacy. These include certain meters, pen needles, syringes, and test strips. Some quantity limits may apply.

Specialty Medicines

Louisiana Healthcare Connections covers many specialty medicines at any in-network pharmacy that is able to fill the medication. Prior authorization may be required. Your provider can ask for prior authorization for these medicines if it is needed.

We cover some medicines known as limited-distribution drugs. These include certain medicines that treat cancer, rare diseases and complex conditions. Some of these drugs can only be filled by pharmacies that are out of state. Prior authorization may be required. Once approved, we can help you find a pharmacy in our network that can fill your prescription.

Compounded Medications

We cover compounded medications when certain rules are followed. Compounded drugs are special mixtures made by pharmacies when a regular medicine doesn’t meet a person’s needs. For the compound mixture to be covered:

• It must include at least two ingredients.
• One of those ingredients must be a medicine that Medicaid covers.
  

The Louisiana Medicaid Single Preferred Drug List (Fee For Service and Managed Care Organizations) is a list of drugs Louisiana Medicaid members can use if prescribed. All Healthy Louisiana Medicaid health plans, including Louisiana Healthcare Connections, follow this PDL.

The PDL applies to drugs you get from retail pharmacies. The PDL is not a complete list of covered drugs. It lists the preferred medications in the most common drug categories. The PDL also links to a list of diabetic supplies that are covered with a prescription. These include certain meters, test strips, pen needles, lancets, syringes and insulin pumps.

You can view the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF) online. For a printed copy of the PDL, call Member Services at 1-866-595-8133 (TTY: 711).

The Louisiana Medicaid Single PDL is reviewed on a regular basis by the Louisiana Department of Health’s Pharmaceutical and Therapeutics Committee. The committee’s goal is to promote the appropriate and cost-effective use of medications.

Excluded Medicines

Some types of medicines are not covered (“excluded”). These include, but are not limited to, medicines for:

• Infertility or impotence
• Cosmetic purposes or hair growth
• Weight gain or weight loss (except orlistat)
• Cough and cold relief (except certain prescription medications approved by Healthy Louisiana Medicaid)
• Vitamins (except those approved by Healthy Louisiana Medicaid)

Filling a Prescription

You must have your prescriptions filled at an in-network pharmacy in Louisiana*. At the pharmacy, you will need to give the pharmacist your prescription and your Louisiana Healthcare Connections Member ID card. To search online for a pharmacy in our network, check out our Find a Provider tool. If you need help finding a pharmacy near you, call Member Services at 1-866-595-8133 (TTY: 711).

If you do not have your Member ID card with you at the pharmacy, you can give this information to the pharmacy to get your prescription:

BIN: 003858
PCN: MA
GROUP: 2ENA
ID: You can use your Medicaid ID number or your Louisiana Healthcare Connections Member ID number

*In rare cases, a Louisiana pharmacy may not be able to fill certain drugs. When this happens, Louisiana Healthcare Connections will allow an out-of-state pharmacy in our network to fill it. 

Refilling a Prescription

In most cases, you will get a 30-day supply of your medications per fill. You do not need to wait until you run out of medicine before you get a refill. Depending on the medicine, pharmacies can refill your prescription 25 to 27 days after your last fill.

Extended Supply for Maintenance Medications and Birth Control Medications

We may cover a 90-day supply of some maintenance medications. These are medicines that are used for long-term health conditions, such as diabetes, high blood pressure, arthritis and more.

To qualify for a 90-day supply:

• The medicine must be on Healthy Louisiana Medicaid’s Maintenance Medication List. You can find this list online at LDH.la.gov/pharmacy.
• You must have been taking the same medicine and strength for at least 60 days in a row.

We also cover up to a six-month supply of some birth control medications. To qualify, you must have been taking the same birth control medicine for six months in a row.

Talk to your doctor or pharmacy to see if your maintenance or birth control medications are eligible for more than a 30-day supply.

To find a pharmacy in our network, you can use our Find a Provider tool. Type in your city or ZIP code to search for pharmacies near you. Only those pharmacies in the Louisiana Healthcare Connections network are listed. If you need help finding a pharmacy, you can also call Member Services at 1-866-595-8133 (TTY: 711).

If you would like a printed list of the in-network pharmacies you can use, please call Member Services at 1-866-595-8133 (TTY: 711).