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Louisiana Healthcare Connections Policies and Procedures Updates

Date: 02/27/25

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.657

Sotatercept (Winrevair)

New

LA.PHAR.332

Pasireotide (Signifor, Signifor LAR)

Material

LA.PHAR.357

Copanlisib (Aliqopa)

Material

LA.PHAR.389

Pegvisomant (Somavert)

Material

LA.PHAR.391

Lanreotide (Somatuline Depot)

Material

LA.PHAR.524

Pegcetacoplan (Empaveli, Syfovre)

Material

LA.PHAR.170

Degarelix Acetate (Firmagon)

Non-Material

LA.PHAR.201

Belatacept (Nulojix)

Non-Material

LA.PHAR.28

Immunization coverage

Non-Material

LA.PHAR.318

Eribulin Mesylate (Halaven)

Non-Material

LA.PHAR.320

Necitumumab (Portrazza)

Non-Material

LA.PHAR.325

Ziv-aflibercept (Zaltrap)

Non-Material

LA.PHAR.352

Daunorubicin/Cytarabine (Vyxeos)

Non-Material

LA.PHAR.393

Leucovorin Injection

Non-Material

LA.PHAR.512

Pegunigalsidase alfa-iwxj (Elfabrio)

Non-Material

LA.PHAR.513

Plasminogen, Human-tvmh (Ryplazim)

Non-Material

LA.PHAR.591

Tofersen (Qalsody)

Non-Material

LA.PHAR.601

Velmanase Alfa-tycv (Lamzede)

Non-Material