Provider Resources
Provider Tools
Provider Manual
The Provider Manual is a resource for participating providers of Ochsner Health Plan.
Out-of-Network Prior Authorization Requests
For OON prior authorization requests, please download the form to your computer and complete the form using Adobe Acrobat. You will not be able to complete the form directly in your web browser.
Please fax it to: 1-833-947-7577.
Provider Quick Reference Guide
A printable reference sheet of contacts and claims information for participating providers of Ochsner Health Plan.
Provider Quick Reference Guide 2025 (PDF) updated 7/24/2025
Current preauthorization lists (Effective January 1, 2025)
Provider Directory
This directory provides a list of Ochsner Health Plan’s current network providers for Acadia, Ascension, East Baton Rouge, East Feliciana, Iberville, Jefferson, Jefferson Davis, Lafayette, Lafourche, Livingston, Orleans, Plaquemines, St. Bernard, St. Charles, St. John the Baptist, St. Landry, St. Martin, St. Tammany, Vermilion, and West Baton Rouge parishes in Louisiana.
2025 Provider Directory
Durable Medical Equipment Providers (DME)
Ochsner Health Plan Freedom and Heroes (HMO POS) members may use Point-of-Service (POS) providers that are outside of our network for an additional cost. Out-of-network/noncontracted providers are under no obligation to treat Ochsner Health Plan members, except in emergency situations. Please call our member services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Prescription Drugs and Pharmacy
Premier and Freedom Plans Part D Formulary*
2025 Formulary
2025 Full List of Covered Drugs Premier and Freedom (PDF)
2025 Premier and Freedom Formulary Online Search (link)
2025 Premier and Freedom List of Drugs Requiring Prior Authorization (PDF) Effective 10/01/2025
2025 Premier and Freedom List of Drugs Requiring Step Therapy (PDF) Effective 10/01/2025
Additional Information About Part D Prescription Drugs*
Important Drug and Pharmacy Information (PDF)
Medication Therapy Management (MTM) Program (PDF)
Personal Medication List (PML) Worksheet (PDF)
Prescription Drug Transition Policy (PDF)
Part D Quality Assurance Program (PDF)
Medicare Part D Prescription Redetermination Form (PDF)
Medicare Prescription Drug Coverage Determination Form (link)
Medicare Prescription Drug Coverage Determination Form (PDF)
Safer Use of Opioid Pain Medication (PDF)
*Not For Use By Ochsner Health Plan Heroes (HMO POS) Plan Members
Dual (HMO D-SNP) Part D Formulary*
2025 Dual (D-SNP) Plan Full List of Covered Drugs (PDF)
2025 Dual (D-SNP) Plan Online Formulary Search (link)
2025 Dual (D-SNP) List of Drugs Requiring Prior Authorization (PDF) Effective 10/01/2025
2025 Dual (D-SNP) List of Drugs Requiring Step Therapy (PDF) Effective 10/01/2025
*For use by Dual (HMO D-SNP) plan members
Ochsner Health Plan Part B Drugs Requiring Prior Authorization
Birdi™ Mail Order Pharmacy
Ochsner Health Plan Members can access the convenience of mail order through: MedImpact Direct Mail Program™ by Birdi®.
- Convert 30 to 90-day fills
- Remind patients to opt-in to auto refills
- Prescribe a one-year supply of medication at each annual visit
- Provide an updated prescription if dose is changed
Setting Up OHP Members with Birdi Mail Order is easy!
ePrescribe in EPIC by selecting:
- Elixir Mail Powered by Birdi - North Canton, OH
- By Fax: 1-888-783-1773
IMPORTANT NOTES:
- Birdi can only accept prescriptions from a prescriber.
- Birdi will automatically fill most new prescriptions, except for controlled substances, and ship for free.
- Refer OHP members to the MedImpact patient portal at
https://www.medimpact/HomeDelivery/Members - Consider adding directives to prescriptions instructing the pharmacy representative to review the member’s Medicare Part D benefit.
Samples, discount cards, VA benefits, and cash or commercial benefits will not close the members Medication Adherence Quality Gap.
Pharmacy Directory
This Pharmacy Directory provides a list of Ochsner Health Plan’s participating pharmacies located within our service area, updated each month. For more recent information or to find Ochsner Health Plan participating pharmacies elsewhere in the United States, please use the Pharmacy Search Tool using your computer or smartphone. You can also call the Ochsner Health Plan Pharmacy Help Desk listed on the back of your Ochsner Member ID Card toll-free at 1-800-910-1837. The Ochsner Health Plan Pharmacy Help Desk is open 24 hours a day, 365 days a year (including holidays).