Prior Authorization

Drugs requiring prior authorization (PA) or having any other restrictions are identified in the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF). A subset of drugs may be subject to additional edits — that criteria can be found in the AmeriHealth Caritas Louisiana non-PDL prior authorization criteria (PDF).

The prescriber must complete, sign, and submit a request for prior authorization or an override of a drug restriction on behalf of a member. Prior authorization requests are to be submitted to Prime Therapeutics Medicaid Administration or PerformRx depending on the type of medication.

Retail Pharmacy (Prescription) Requests
Direct requests to Prime Therapeutics Medicaid Administration

Medical Injectable (Provider-administered) Requests
Direct requests to PerformRx

  • Phone: 1-800-684-5502
  • Fax: 1-855-452-9131

Regardless of the type of prior authorization, all written requests for medications must be made using the Louisiana uniform prescription drug PA request form (PDF).

Prescribers may request copies of the criteria used to make the prior authorization determination by contacting the Prime Therapeutics Medicaid Administration Help Desk at 1-800-424-1664.

In most cases where the prescribing health care professional/provider has not obtained prior authorization, members will receive a three-day emergency supply of the medication.

Pharmacy