Louisiana Healthcare Connections Policies and Procedures Updates
Date: 05/11/26
Louisiana Healthcare Connections is sharing with providers the below policies and procedures that were developed and/or revised; posted for public comment and approved by LDH in accordance with La. R.S. 46:460.54. Non-material revisions do not require LDH approvals.
Please share this notice with other members of your practice and office staff as necessary.
These guidelines will be implemented 30 days from the date of this notice and will be posted on our Clinical & Payment Policies page.
Policy & Procedure # | Policy & Procedure Title | New, material revisions, non-material revisions |
LA.PHAR.308 | Elotuzumab (Empliciti) | Material |
LA.PHAR.685 | Tarlatamab-dlle (Imdelltra) | Material |
LA.PHAR.282 | Parathyroid Hormone (Natpara) | Material |
LA.PHAR.600 | Trofinetide (Daybue, Daybue Stix) | Material |
LA.PHAR.481 | Idecabtagene Vicleucel (Abecma) | Material |
LA.PHAR.678 | Afamitresgene autoleucel (Tecelra) | Material |
LA.PHAR.189 | Ibandronate Injection (Boniva) | Material |
LA.PHAR.321 | Panitumumab (Vectibix) | Material |
LA.PHAR.339 | Durvalumab (Imfinzi) | Material |
LA.PHAR.687 | Tislelizumab-jsgr (Tevimbra) | Material |
LA.PHAR.317 | Cetuximab (Erbitux) | Material |
LA.PHAR.405 | Inotersen (Tegsedi) | Material |
LA.PHAR.158 | Agalsidase Beta (Fabrazyme) | Material |
LA.PHAR.93 | Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev) | Material |
LA.PHAR.634 | Epcoritamab-bysp (Epkinly) | Material |
LA.PHAR.165 | Ferumoxytol (Feraheme) | Material |
LA.PMN.53 | Off-Label Use | Material |
LA.PMN.255 | No Coverage Criteria | Material |
LA.PHAR.05 | Hyaluronate Derivatives | Material |
LA.PHAR.495 | Mitomycin Instillation Solution (Jelmyto, Zusduri) | Material |
LA.PHAR.720 | Nipocalimab-aahu (Imaavy) | Material |
LA.PHAR.184 | Aflibercept (Eylea, Eylea HD) and Biosimilars) | Material |
LA.PHAR.618 | Mosunetuzumab-axgb (Lunsumio) | Material |
LA.PHAR.181 | Hemin (Panhematin) | Material |
LA.PHAR.402 | Emapalumab-lzsg (Gamifant) | Material |
LA.PHAR.322 | Pembrolizumab, Pembrolizumab-Berahyaluronidase Alfa-pmph (Keytruda, Keytruda Qlex) | Material |
LA.PHAR.483 | Lisocabtagene Maraleucel (Breyanzi) | Material |
LA.PHAR.598 | Lifileucel (Amtagvi) | Material |
LA.PHAR.675 | Obecabtagene autoleucel (Aucatzyl) | Material |
LA.PHAR.362 | Axicabtagene ciloleucel (Yescarta) | Material |
LA.PHAR.444 | Afamelanotide (Scenesse) | Material |
LA.PHAR.445 | Brolucizumab-dbll (Beovu) | Material |
LA.PHAR.521 | Avalglucosidase Alfa-ngpt (Nexviazyme) | Material |
LA.PHAR.522 | Margetuximab-cmkb (Margenza) | Material |
LA.PHAR.523 | Naxitamab-gqgk (Danyelza) | Material |
LA.PHAR.570 | Ropeginterferon Alfa-2b-njft (BESREMi) | Material |
LA.PHAR.574 | Sirolimus Protein-Bound Particles (Fyarro) | Material |
LA.PHAR.52 | Interferon Gamma-1b (Actimmune) | Material |
LA.PHAR.581 | Faricimab-svoa (Vabysmo) | Material |
LA.PHAR.94 | Alpha1-Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) | Material |
LA.PHAR.616 | Zilucoplan (Zilbrysq) | Material |
LA.PHAR.234 | Ferric Carboxymaltose (Injectafer) | Material |
LA.PHAR.410 | Bortezomib (Velcade) | Material |
LA.PHAR.711 | Cosibelimab-Ipdl (Unloxcyt) | Material |
LA.PHAR.713 | Zenocutuzumab-zbco (Bizengri) | Material |