Pharmacy
It’s important to Louisiana Healthcare Connections that our members receive drug therapy that is appropriate, high quality and cost effective. We work hard to ensure you have access to safe and effective medications that are medically proven to help you get healthy and stay healthy.
Prime Therapeutics State Government Solutions (Prime Therapeutics) manages pharmacy benefits for all Healthy Louisiana Medicaid health plans, including Louisiana Healthcare Connections. For any pharmacy-related issues or questions, call Prime Therapeutics' 24/7 Member Help Desk at 1-800-424-1664 (TTY: 711).
Prescription Drugs and Over-the-Counter Drugs
Louisiana Healthcare Connections covers certain prescription drugs and over-the-counter drugs when prescribed by a Louisiana Healthcare Connections provider and filled by a pharmacy in Prime Therapeutics' network. The pharmacy program does not cover all drugs. Some require prior authorization. Some drugs have limitations on age, dosage, or maximum quantities. These limits make sure your medicines are safe and effective.
The Louisiana Medicaid Single Preferred Drug List (Fee For Service and Managed Care Organizations) is a list of drugs Louisiana Medicaid members can use if prescribed. All Healthy Louisiana Medicaid health plans, including Louisiana Healthcare Connections, follow this PDL.
The PDL applies to drugs you get from retail pharmacies. The PDL is not a complete list of covered drugs. It lists the preferred medications in the most common drug categories. The PDL also links to a list of diabetic supplies that are covered with a prescription. These include certain meters, test strips, pen needles, lancets, syringes, and insulin pumps.
You can view the Louisiana Medicaid Single PDL (Fee For Service and Managed Care Organizations) (PDF) online. For a printed copy of the PDL, call Prime Therapeutics, Louisiana Medicaid’s Pharmacy Benefits Manager, at 1-800-424-1664 (TTY: 711).
The Louisiana Medicaid Single PDL is reviewed on a regular basis by the Louisiana Department of Health’s Pharmaceutical and Therapeutics Committee. The committee’s goal is to promote the appropriate and cost-effective use of medications.
You can have your prescriptions filled at a pharmacy in Prime Therapeutics' network. At the pharmacy, you will need to give the pharmacist your prescription and your Louisiana Healthcare Connections member ID card. If you need help finding a pharmacy near you, call Prime Therapeutics' 24/7 help desk at 1-800-424-1664 (TTY: 711) or use Prime Therapeutics' Find a Pharmacy tool.
If you do not have your Member ID card with you at the pharmacy, you can give this information to the pharmacy to get your prescription:
BIN: 025986
PCN: 1214172240
GROUP: LAMCOPBM
ID: You can use your Medicaid ID number or your Louisiana Healthcare Connections Member ID number
To find a pharmacy in Prime Therapeutics' network, you can use their Find a Pharmacy tool. Type in your city or ZIP code to search for pharmacies near you. Only those pharmacies in the Prime Therapeutics network are listed. If you need help finding a pharmacy, you can also call Prime Therapeutics at 1-800-424-1664 (TTY: 711).
If you would like a printed list of the in-network pharmacies you can use, please call Prime Therapeutics at 1-800-424-1664 (TTY: 711).
Prescription Copays
For many members, medications are covered at no cost to you. Some members may need to pay for a small portion of their medications. This is called a “copay.” Louisiana Healthcare Connections pays for the rest of the cost.
The total amount you pay for medicine can’t be more than 5% of your family’s household income each month. Once you reach this limit, you won’t have any more copays for the rest of the month.
| Prescription Cost | Copay |
|---|---|
| $5.00 or less | $0.00 |
| Between $5.01 and $10.00 | $0.50 |
| Between $10.01 and $25.00 | $1.00 |
| Between $25.01 and $50.00 | $2.00 |
| More than $50.01 | $3.00 |
There are no copays for:
- Emergency services
- Family planning supplies
- Certain preventive medications
- Tobacco cessation products
- Vaccines
There are no copays for members who are:
- Pregnant
- Children under the age of 21
- In a long-term care facility
- In hospice care
- Native Americans
- Alaska Natives
- Home and Community Based Waiver recipients
- Eligible for Medicaid due to breast or cervical cancer