§460.33. Prior authorization form; requirements

A. There shall be a single uniform prescription drug prior authorization form used by all Medicaid managed care organizations, including any Medicaid managed care organization pharmacy benefit managers. The requirement for a single uniform prescription drug prior authorization form shall not apply to prior authorization of specialty drugs or in cases where electronic prescriptions are utilized. All managed care organizations shall use a single uniform prescription drug prior authorization form, not to exceed two pages, excluding guidelines or instructions, that has been jointly promulgated by the Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners in accordance with the Administrative Procedure Act. A Medicaid managed care organization may include organization specific information on the form, including but not limited to the organization's name, address, logo, and other contact information for the organization. A health care provider may submit the prior authorization form electronically if the Medicaid managed care organization allows for submission of the form in this manner.

B. The Louisiana Board of Pharmacy and the Louisiana State Board of Medical Examiners shall promulgate rules and regulations prior to January 1, 2019, that establish the form which shall be utilized by all Medicaid managed care organizations. The boards may consult with the health insurance issuers, Medicaid managed care organizations, Louisiana Department of Health, and Department of Insurance as necessary in development of the prior authorization form.

C. Pursuant to its contract with any Medicaid managed care organization, the department shall assess sanctions against any Medicaid managed care organization that directly or through its pharmacy benefit managers, utilizes any prescription drug prior authorization form other than the single uniform prescription drug prior authorization form provided for in this Section.

D. The single uniform prescription drug prior authorization form provided for in this Section shall be the same as provided for in R.S. 22:1006.1.

Acts 2013, No. 312, §1, eff. Jan. 1, 2014; Acts 2018, No. 423, §2, eff. Jan. 1, 2019.