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Louisiana Healthcare Connections Policies and Procedures Updates

Date: 06/08/26

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.610

Sodium thiosulfate (Pedmark)

Material

LA.PHAR.160

Alglucosidase Alfa (Lumizyme)

Material

LA.PHAR.301

Erwinia Asparaginase (Erwinaze, Rylaze)

Material

LA.PHAR.330

Protein C Concentrate, Human (Ceprotin)

Material

LA.PHAR.567

Cipaglucosidase alfa-atga--miglustat (Pombiliti-Opfolda)

Material

LA.PHAR.617

Mirvetuximab soravatansine-gynx (Elahere)

Material

LA.PHAR.629

Retifanlimab-dlwr (Zynyz)

Material

LA.PHAR.709

Zanidatamab-hrii (Ziihera)

Material

LA.PHAR.705

Zolbetuximab-clzb (Vyloy)

Material

LA.PHAR.564

Antithrombin III (ATryn, Thrombate III)

Material

LA.PHAR.310

Daratumumab Daratumumab-Hyaluronidase-fihj (Darzalex, Darzalex, Faspro)

Material

LA.PHAR.192

Epoprostenol (Flolan, Veletri)

Material

LA.PHAR.455

Enfortumab Vedotin-ejfv (Padcev)

Material

LA.PHAR.187

Verteporfin (Visudyne)

Material

LA.PHAR.204

Trabectedin (Yondelis)

Material

LA.PHAR.333

Avelumab (Bavencio)

Material

LA.PHAR.361

Tisagenlecleucel (Kymriah)

Material

LA.PHAR.372

Voretigene Neparvovec-rzyl (Luxturna)

Material

LA.PHAR.40

Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia, Mycapssa)

Material

LA.PHAR.668

Toripalimab-tpzi (Loqtorzi)

Material

LA.PHAR.595

Eladocagene Exuparvovec-tneq (Kebilidi)

Material

LA.PHAR.329

Siltuximab (Sylvant)

Material

LA.PHAR.379

Eteclacalcetide (Parsabiv)

Material

LA.PHAR.270

Paricalcitol Injection (Zemplar)

Material

LA.PHAR.611

Teclistamab-cqyv (Tecvayli)

Material

LA.PHAR.743

Linvoseltamab-gcpt (Lynozyfic)

Material

LA.PHAR.11

Burosumab-twza (Crysvita)

Material

LA.PHAR.480

Ferric Derisomaltose (Monoferric)

Material

LA.PHAR.227

Pertuzumab (Perjeta), Pertuzumab-dpzb (Poherdy)

Material

LA.PHAR.715

Datopotamab deruxtecan-dlnk (Datroway)

Material