Changes to Medicaid Pharmacy Benefit Management (PBM) Effective October 1, 2025 (IB 25-25)

Date: 09/23/25

Louisiana Healthcare Connections is sharing with providers Changes to Medicaid Pharmacy Benefit Management (PBM) Effective October 1,  2025 (IB 25-25).

Effective October 1, 2025, the Louisiana Medicaid program will phase out its single Pharmacy Benefit Manager (PBM). Instead, each Healthy Louisiana managed care organization (MCO) will manage its own pharmacy services—including prior authorizations, claims processing, and prescription coverage—through its designated PBM.

This change will not affect fee-for-service (FFS) beneficiaries or those with behavioral-healthonly coverage. FFS pharmacy services will remain with Gainwell Technologies, and prior authorization requests will continue to be handled by the University of Louisiana at Monroe.

Pharmacies should continue normal operations with Prime Therapeutics as the Healthy Louisiana single PBM until October 1, 2025.

Existing prior authorizations will be transferred to the new MCO-specific PBMs and remain in effect. Be aware that during the transition, some patients may present ID cards containing outdated PBM details.Pharmacies can download the PBM transition quick reference flyer (PDF) for updated PBM information for all the Medicaid health plans.