Louisiana Department of Health & Hospitals | Kathy Kliebert, Secretary

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Statewide Initiatives

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Standard Pharmacy Prior Authorization Form for Prepaid Health Plans Revised

Tuesday, May 6, 2014  |  Contact: Bayou Health (225) 342-7878

All Bayou Health Prepaid Plans accept a standard single page prior authorization form for outpatient pharmacy services. The purpose of the form is to streamline and simplify the pharmacy prior authorization process for providers who contract with multiple Bayou Health Prepaid Plans. Providers may now expedite PA requests by checking the appropriate box. The standard form is a complement to Plans' existing prior authorization processes, which providers may continue to use. The form also is available on each Prepaid Health Plan's website, along with instructions for its use.

Pharmacy Prior Authorization Form