August 20, 2021
In response to the COVID-19 pandemic and Public Health Emergency (PHE), and more recently the COVID-19 delta variant spread, the Louisiana Medicaid pharmacy program has updated coverage for COVID-19 vaccines. Currently, the Pfizer, Moderna, and Johnson & Johnson (Janssen) COVID-19 vaccines are covered by the Louisiana Medicaid pharmacy program at no cost to the beneficiary. COVID vaccine coverage is updated to include coverage of a third dose of the Pfizer and Moderna vaccines for immunocompromised individuals (Medical benefit
implemented August 12, 2021; Pharmacy benefit implementation planned for September 1, 2021). Also, COVID19 vaccine coverage is expanded to include reimbursement for pharmacy claims submitted for at-home administration of the COVID-19 vaccine (Medical benefit implemented June 8, 2021; Pharmacy benefit implementation planned for September 1, 2021). An updated provider notice with detailed billing instructions will be posted soon.
Respiratory Syncytial Virus (RSV) and Palivizumab (Synagis®) Coverage
Based on expert opinion and Centers for Disease Control (CDC) National Respiratory and Enteric Virus Surveillance System (NREVSS) data, on July 15, 2021, the Louisiana Medicaid pharmacy program continued coverage of palivizumab (Synagis®) outside the usual respiratory syncytial virus (RSV) season. Palivizumab is indicated for the prevention of serious lower respiratory tract infection caused by RSV in selected infants and young children at high risk of RSV disease. All prescriptions for palivizumab require clinical authorization. The updated Palivizumab Clinical Authorization Form and criteria are posted on the Single Preferred Drug List (PDL). The Single PDL can be found at the following link: https://ldh.la.gov/assets/HealthyLa/Pharmacy/PDL.pdf.
Effective September 15, 2021, the Louisiana Medicaid pharmacy program will reimburse for the influenza vaccine (2021-2022 Flu Season) when administered by a vaccinating pharmacist.