[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288932-105":53,"doc-detail-288932-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","louisiana-medicaid-pharmacy-point-of-sale-quantity-limits-january-2026-memorandum","Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - January 2026 - Memorandum","","Memorandum dated December 4, 2025 from Seth Gold, Medicaid Executive Director, to Louisiana Medicaid prescribing providers and pharmacists. It announces new Point of Sale (POS) pharmacy quantity limits effective January 1, 2026 for Fee for Service (FFS) and Managed Care Organizations (MCOs), with specific denial and override handling. It details POS denial behavior for claims exceeding maximum quantities, FFS override with NCPDP codes, and MCO limits requiring prior authorization, plus medication-specific quantity limits and additional Dupixent diagnosis-specific updates.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/louisiana-medicaid-pharmacy-point-of-sale-quantity-limits-january-2026-memorandum/288932/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/louisiana-medicaid-pharmacy-point-of-sale-quantity-limits-january-2026-memorandum/288932.png","ImageObject",442,249,{"name":88,"@type":89},"Sophia Brooks","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-07","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"When do the new Louisiana Medicaid POS quantity limits take effect?","Question",{"text":109,"@type":110},"Effective January 1, 2026, the Louisiana Medicaid FFS pharmacy program and MCOs will implement the new POS quantity limits.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What happens at POS when a pharmacy claim exceeds the maximum quantity limit?",{"text":114,"@type":110},"Claims exceeding the limit will deny at POS, with FFS denials mapped to an NCPDP rejection error 88 associated with the program maximum.",{"name":116,"@type":107,"acceptedAnswer":117},"How can an FFS pharmacist override a POS denial for excessive quantity?",{"text":118,"@type":110},"After consulting the prescriber to verify medical necessity, the pharmacist may override at POS by submitting the specified NCPDP override codes: 439-E4, 440-E5, and 441-E6.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288932,1790156226,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":73},962084925636,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","多tate of 2ouisíana  \n# Louisiana Department of HealthBureau of Health Services Financing\n\nMEMORANDUM  \nDATE:  \nDecember 4,2025  \nTO:  \n# All Louisiana Medicaid Prescribing Providers and Pharmacists\n\n女  \nFROM:  \nSeth Gold,Medicaid Executive Director  \n# SUBJECT:Louisiana Medicaid Pharmacy Point of SaleQuantity Limits-January 2026\n\nEffective January 1,2026,the Louisiana Medicaid Fee for Service(FFS)PharmacyProgram and Managed Care Organizations(MCOs),in consultation with the DrugUtilization Review(DUR)Board,will implement new Point of Sale(POS)quantity limits.These quantity limits will apply to pharmacy claims submitted to Gainwell Technologiesfor FFS and the Pharmacy Benefits Manager(PBM)for MCOs(Aetna,AmeriHealthCaritas,Healthy Blue,Humana Healthy Horizons,Louisiana Healthcare Connections,andUnitedHealthcare).  \n# Point of Sale Quantity Limits\n\nPharmacy claims that exceed the maximum quantity limit,will deny at POS with:  \n● Denial from Gainwell Technologies(FFS Only):NCPDP rejection error 88(DUR Reject Error)mapped to EOB Code 457(Quantity and/or days'supplyexceeds program maximum).  \nDciD frejection cdceos Only;:The pharmacy claim will deny with an  \nFFS Only Override:Upon consultation with the prescriber to verify medical necessity ofthe excessive quantity,the pharmacist may override the denial by submitting thefollowing override codes at POS:  \nNCPDP 439-E4 Field (Reason for Service Code)-EX(Excessive Quantity)  \nNCPDP 440-E5 Field(Professional Service Code)-MO(Prescriber Consulted)  \nNCPDP441-E6 Field (Result of Service Code)-1G(Filled with Prescriber Approval)  \nLouisiana Medicaid Pharmacy Point of Sale Quantity Limits-January 2026December 4,2025Page 2  \nMCO Quantity Limit Override:The override procedure is a Prior Authorization process.The pharmacy will not be able to override the quantity limit at POS using NCPDPoverride codes.  \nThe agents listed in the following charts have a quantity limit at Point of Sale(POS).  \n\n| Medications with Quantity Limits   | Quantity Limit   |\n| --- | --- |\n| Chronic GI Motility Agents   |  |\n| ·Alosetron Tablet(Lotronex®   | 2 tablets per day   |\n| ·Eluxadoline Tablet(Viberzi⑧   | 2 tablets per day   |\n| ·Linaclotide Capsule (Linzess®   | 1 capsule per day   |\n| ·Lubiprostone Capsule (Amitiza®   | 2 capsules per day   |\n| ·Methylnaltrexone Syringe(Relistor⑧   | 30 syringes per 30 days   |\n| ·Methylnaltrexone Tablet (Relistor⑧)   | 3 tablets per day   |\n| ·Naldemedine Tablet (SymproicR   | 1 tablet per day   |\n| ·Naloxegol Tablet(Movantik®)   | 1 tablet per day   |\n| ·Plecanatide Tablet(TrulanceR)   | 1 tablet per day   |\n| ·Prucalopride Tablet(Motegrity®)   | I tablet per day   |\n| ·Tenapanor Tablet (IbsrelaR)   | 2 tablets per day   |\n| Atrasentan (VanrafiaR)   | 1 tablet per day   |\n| Berdazimer(ZelsuvmiTM)   | 2 kits per 84 days  \u003Cbr>not to exceed 4 kits in a rolling 365 days   |\n| Deuruxolitinib Tablet (LeqselviTM)   | 2 tablets per day   |\n| Eplontersen Autoinjector(WainuaTM)   | l autoinjector every month   |\n| Fitusiran(QfitliaTM)   | 1 injection (pen /vial)per 28 days   |\n| Insulin Aspart-szjj Pen(MerilogTM SolostarR)   | 45ml per 30 days   |\n| Insulin Aspart-szjj Vial(MerilogTM)   | 50ml per 30 days   |\n| Iptacoptan (Fabhalta®)   | 2 capsules per day   |\n| Rizatriptan and Meloxicam (SymbravoR   | 9 tablets per rolling 30 days   |\n| Patisiran Vial(OnpattroTM)   | 3 vials every 3 weeks   |\n| Sitagliptin Oral Solution (BrynovinTM)   | 120ml per 30 days   |\n| Tirzepatide Syringe (ZepboundTM)-  \u003Cbr>Quantity limit override procedure will be a PA  \u003Cbr>process for FFS and MCO   | 4 syringes(1 carton)per 28 days   |\n| Treprostinil Capsules (YutrepiaTM)   | 26.5mcg-5 cartons per 28 days   |\n|  | 53mcg-5 cartons per 28 days   |\n|  | 79.5mcg-10 cartons per 28 days   |\n|  | 106mcg-8 cartons per 28 days   |\n| Vibegron Tablet(Gemtesa®)   | 1 tablet per day   |\n| Vutrisiran Syringe(AmvuttraTM)   | 1 syringe every 3 months   |\n\n# Louisiana Medicaid Pharmacy Point of Sale Quantity Limits -Januar","cbCaii1bznltnNSy","https://ap.wps.com/l/cbCaii1bznltnNSy","pdf",1452654,"English","# Point of Sale Quantity Limits\n## Denial rules for quantity-exceeding claims\n## FFS quantity limit override (NCPDP codes)\n## MCO quantity limit override (prior authorization)\n## Medication quantity limit table\n## Dupixent diagnosis-specific updates\n## Additional information and contacts","[{\"question\":\"When do the new Louisiana Medicaid POS quantity limits take effect?\",\"answer\":\"Effective January 1, 2026, the Louisiana Medicaid FFS pharmacy program and MCOs will implement the new POS quantity limits.\"},{\"question\":\"What happens at POS when a pharmacy claim exceeds the maximum quantity limit?\",\"answer\":\"Claims exceeding the limit will deny at POS, with FFS denials mapped to an NCPDP rejection error 88 associated with the program maximum.\"},{\"question\":\"How can an FFS pharmacist override a POS denial for excessive quantity?\",\"answer\":\"After consulting the prescriber to verify medical necessity, the pharmacist may override at POS by submitting the specified NCPDP override codes: 439-E4, 440-E5, and 441-E6.\"}]","Louisiana Medicaid Pharmacy Point of Sale Quantity Limits - January 2026 - Memorandum | PDF",1789634242]