Amendment vs bill House Committee Amendment, #4624, INS, Draft vs Enrolled

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Regular Session ENROLLED SENATE BILL NO.
HCASB387 4902 4624 HOUSE COMMITTEE AMENDMENTS Regular Session Amendments proposed byHouse Committee on Insurance to Reengrossed Senate Bill No.
387 BY SENATORS BASS AND TALBOT AND REPRESENTATIVE TURNER AN ACT To amend and reenact R.S.
by Senator Bass AMENDMENT NO.
22:1856.1(B)(2)(a), 1863, 1865(A), and the introductory paragraph of 1865(G), R.S.
1 On page 6, between lines 17 and 18, insert the following:
39:1600.1(A), the introductoryparagraphof 1600.1(D), and 1600.1(D)(6), and R.S.
"(23) Net acquisition cost" means the amount paid to acquire a prescription drug after deducting all rebates, price concessions, administrative fees, and any other payments or economic benefits received directly or indirectly by the pharmacy benefit manager or any related entity in connection with the selection, placement, or dispensing of that drug, calculated from the perspective of the health benefit plan and not the PBM." AMENDMENT NO.
44:4.1(B)(11), to enact R.S.
2 On page 9, line 6, after "on" and before "a" delete "either" AMENDMENT NO.
22:1867.1 and 1868.2, and to repeal R.S.
3 On page 9, line 7, after "per-prescription" and before "basis" insert "or per-event" AMENDMENT NO.
22:1868.1 and Section 5 of Act 474 of the 2025 Regular Session, relative to pharmacybenefit managers;
4 On page 12, at the beginning of line 4, after "(5)" insert "(a)" AMENDMENT NO.
to provide for definitions;
5 On page 12, between lines 19 and 20, insert the following:
to provide for the costs of implementation and enforcement;
"(b) Nothing in this Paragraph shall be construed to prohibit the commissionerfromdisclosing informationtoaPrescriptionDrugAffordabilityBoard established pursuant to this Title if, such information is subject to the confidentiality protections applicable to that board." AMENDMENT NO.
to provide for appeals;
6 On page 12, line 23, change "2027" to "2028" AMENDMENT NO.
to provide for a duty to enrollees, health plans, and providers;
7 On page 14, line 7, after "provided" delete the remainder of the line and insert in lieu thereof "in the same formulary tier and cost-sharing structure for the" AMENDMENT NO.
to provide for compensation;
8 On page 16, after line 16, add the following:
to provide for rebates, formularies, and cost-sharing;
"Section 5.
to provide for a private cause of action;
The provisions of this Act shall apply to any new policy, contract, program, or health coverage plan issued on or after January 1, 2028.
to provide for audits;
Any policy, contract, program,orhealthcoverageplanin effectpriortoJanuary1,2028,shallconverttoconform to the provisions of this Act on or before the renewal date, but no later than January 1, 2029." Page 1 of 1 CODING:
to provide for contract and other requirements;
Wordsinstruckthroughtypearedeletionsfromexistinglaw;wordsunderscored are additions.
to provide for data sharing;
to provide for penalties;
to provide for a public records exemption;
to provide for an effective date;
and to provide for related matters.
Be it enacted by the Legislature of Louisiana:
Section 1.
R.S.
22:1856.1(B)(2)(a), 1863, 1865(A), and the introductory paragraph of 1865(G) are hereby amended and reenacted and R.S.
22:1867.1 and 1868.2 are hereby enacted to read as follows:
§1856.1.
Pharmacy record audits;
recoupment;
appeals * * * B.Notwithstandinganyotherprovisionoflawtothecontrary,whenanaudit of the records of a pharmacyis conducted by an entity, the audit shall be conducted in accordance with the following criteria:
* * * (2)(a)Noentityshallconductanauditataparticularpharmacymorethanone time annually.
The audit shall be limited to claims submitted not more than twelve months prior to date the audit begins.
However, the provisions of this Paragraph shall not apply when an entity must return to a pharmacyto complete an audit already in progress, or there is an identified history of errors, an identified Page 1 of 19 Coding:
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SB NO.
387 ENROLLED activitywhichareasonablemanpersonwouldbelievetobeinappropriate,orillegal activity that the entity has brought to the attention of the pharmacy owner or corporate headquarters of the pharmacy.
* * * §1863.
Definitions As used in this Subpart, the following definitions apply:
(1) "Drug Shortage List" means a list of drug products posted on the United States Food and Drug Administration drug shortage website.
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(2) "Effective rate pricing" means any payment reduction for pharmacist or pharmacyservicesbyapharmacybenefitmanagerunderareconciliationprocessfor direct or indirect remuneration fees, a brand or generic effective rate of reimbursement, or any other reduction or aggregate reduction of payment.
(3) "Enrollee" means any individual entitled to coverage of healthcare services under the terms of a health benefit plan.
(3)(4) "Health benefit plan", "health plan", "plan", "benefit", or "health insurance coverage" means services consisting of medical care provided directly throughinsurance,reimbursement,orothermeans,andincludingitemsandservices paid for as medical care under anyhospital or medical service policyor certificate, hospital or medical service plan contract, preferred provider organization contract, or health maintenance organization contract offered by a health insurance issuer.
However, excepted benefits are not included as a "health benefit plan".
(5) "Healthcare service" means an item or service furnished to any individual for the purpose of preventing, diagnosing, alleviating, curing, or healing human illness, injury, or physical disability.
(4)(6)"Healthinsuranceissuer"meansanyentitythatoffershealthinsurance coverage through a plan, policy, or certificate of insurance subject to state law that regulates the business of insurance.
"Health insurance issuer" shall also include a health maintenance organization, as defined and licensed pursuant to Subpart I of Part I of Chapter 2 of this Code.
(5)(7)"Localpharmacy"meansapharmacyasdefinedintheNorthAmerican Page 2 of 19 Coding:
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SB NO.
387 ENROLLED Industry Classsification Classification System (NAICS) Code 456110, which is domiciled in Louisiana and has fewer than ten retail outlets under its corporate umbrella, or which is owned and operated by a nonprofit health system, or any affiliated hospital, domiciled in Louisiana.
(6)(8)"MaximumAllowableCostList"meansalistingoftheNationalDrug Code used by a pharmacy benefit manager setting the maximum allowable cost on which reimbursement to a pharmacy or pharmacist may be based.
"Maximum Allowable Cost List" shall include any term that a pharmacy benefit manager or a healthcare insurer may use to establish reimbursement rates for generic and multi-source brand drugs to a pharmacist or pharmacyfor pharmacist services.
(7)(9)"NDC"meanstheNationalDrugCode,anumericalidentifierassigned to all prescription drugs.
(10)"Person"includesanaturalperson,corporation,mutualcompany, unincorporated association, partnership, joint venture, limited liability company, trust,estate,foundation, not-for-profitcorporation,unincorporated organization, government or governmental subdivision, or agency.
(8)(11)"Pharmacist"meansalicensedpharmacistasdefinedinR.S.22:1852.
(9)(12) "Pharmacist services" means products, goods, or services provided as a part of the practice of pharmacyas defined in R.S.
22:1852.
(10)(13) "Pharmacy" means any appropriately licensed place where prescription drugs are dispensed as defined in R.S.
22:1852.
(14) "Pharmacy benefit management fee" means a fee that covers the cost of providing one or more pharmacy benefitmanagementservicesand that does not exceed the value of the service or services actually performed by the pharmacy benefit manager.
(15) "Pharmacy benefit management service" means any of the following:
(a)Negotiatingthepriceofprescriptiondrugs,includingnegotiatingand contractingfordirectorindirectrebates,discounts, orotherpriceconcessions.
(b)Managinganyaspectofaprescriptiondrugbenefitincludingbutnot Page 3 of 19 Coding:
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SB NO.
387 ENROLLED limited to the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests,theadjudication of appeals or grievances relatedtothe prescriptiondrugbenefit,contractingwithnetworkpharmacies,controllingthe cost of covered prescription drugs, managing or providing data relating to the prescription drug benefit, or the provision of services related thereto.
(c) Performance of any administrative, managerial, clinical, pricing, financial, reimbursement, data administration or reporting, or billing service.
(d) Such other services as the commissioner may define by rule or regulation.
(11)(16) "Pharmacy benefit manager" or "PBM" has the same meaning as the term defined in R.S.
22:1641 and includes any person, either directly or indirectly, that provides one or more pharmacy benefit management services on behalf of an insurer or health plan, and anyagent, contractor,intermediary, affiliate, subsidiary, or related entity of such person who facilitates, provides, directs, or overseesthe provision ofthe pharmacybenefit management servicesor entity, and any subsidiary, parent, or affiliate of such entity that directly or indirectly facilitates,provides,directs,manages,administers,oroverseestheprovisionof one or more pharmacy benefit management services.
The administration or management of a prescription benefits plan includes direct or indirect participation at any stage in the negotiation or determination of prescription drugpricingultimatelyassessedtoaninsurer'sorpharmacybenefitmanager's client health benefit plan.
(12)(17) "Pharmacy benefits plan" or "pharmacy benefits program" means aplanorprogramthatpaysfor,reimburses,coversthecostof,orotherwiseprovides for pharmacist services to individuals who reside in or are employed in Louisiana.
(18) "Provider" means an individual or entity that furnishes, provides, dispenses, or administers one or more units of a prescription drug.
(13)(19)"Rebates"meanseitherofthefollowing:allrebates,discounts,and other price concessions, based on utilization of a prescription drug and paid by the Page 4 of 19 Coding:
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SB NO.
387 ENROLLED manufacturer or other party other than an enrollee, directly or indirectly, to the pharmacy benefit manager after the claim has been adjudicated at the pharmacy.
Rebates shall include a reasonable estimate, as determined bythe commissioner, of any volume-based discount or other discounts.
(a) Drug manufacturer price concessions including but not limited to base price concessions, whether described as a rebate or otherwise, and any price protection rebates and performance-based price concessions that may accruedirectlyorindirectlytothepharmacybenefitmanager,healthinsurance issuer or health plan, or other party on behalf of the health insurance issuer or health plan, including a pharmacy benefit manager, from a manufacturer, dispensing pharmacy, or other party in connection with the dispensing or administration of a prescription drug.
(b) Reasonable estimates of any price concessions, fees, and other administrative costs that are passed through, or are reasonably anticipated to be passed through, to the health insurance issuer or health plan and serve to reduce the health insurance issuer or health plan's liabilities for a prescription drug.
(20) "Related entity" means either of the following:
(a) Any entity, whether foreign or domestic, that is a member of any controlled group of corporations, as defined in Section 1563(a) of the Internal Revenue Code, except that "fifty percent" shall be substituted for "eighty percent" wherever the latter percentage appears in the code, of which a pharmacy benefit manager is a member.
(b) Any of the following persons or entities that are treated as a related entity to the extent provided in rules adopted by the commissioner:
(i) A person other than a corporation that is treated under the rules as a related entity of a pharmacy benefit manager.
(ii) A person or entity that is treated under the rules as affiliated with a pharmacy benefit manager in cases where the pharmacy benefit manager is a person other than a corporation.
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SB NO.
387 ENROLLED (14)(21) "Specialty drug" means a drug that meets all of the following criteria:
(a) The drug is used to treat and is prescribed for a person with a complex, chronic, or rare medical condition that is progressive, can be debilitating or fatal if left untreated or undertreated, or for which there is no known cure.
(b) The drug is not routinelystocked at a majority of pharmacies within this state.
(c) The drug has special handling, storage, inventory, or distribution requirements.
(d) Patients receiving the drug require complex education and treatment maintenance, such as complex dosing, intensive monitoring, or clinical oversight.
(15)(22) "Spread pricing" means any amount charged or claimed by a pharmacy benefit manager for a prescription drug that exceeds the amount paid by the pharmacy benefit manager to the pharmacist or pharmacy for the dispensing of the prescription drug, minus a pharmacy benefit management fee.
(23) "Net acquisition cost" means the amount paid to acquire a prescription drug after deducting all rebates, price concessions, fee payments, and any otherpaymentsoreconomic benefits receiveddirectly or indirectly by the pharmacy benefit manager or any related entity in connection with the selection,placement,ordispensingofthatdrug,calculatedfromtheperspective of the health benefit plan and not the pharmacy benefit manager.
* * * §1865.
Appeals;
maximum allowable costs A.(1) The pharmacy benefit manager shall provide a reasonable administrative appeal procedure to allow pharmacies to challenge maximum allowable costs for a specificNDC or NDCs as not meetingthe requirementsof this Subpartorbeingbelowthecost atwhichthepharmacymayobtaintheNDC.Within fifteen business days after the applicable fill date, a pharmacymayfile an appeal by following the appeal process as provided for in this Subpart.
The pharmacy benefit managershall respondtoachallengewithin fifteenbusiness days afterreceiptofthe Page 6 of 19 Coding:
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SB NO.
387 ENROLLED challenge.
(2) The administrative appeal procedure shall allow a pharmacy or pharmacist the option to submit a consolidated appeal representing multiple substantially similar claims.
* * * G.
The commissioner may impose a reasonable fee upon pharmacy benefit managers, in accordance with the Administrative Procedure Act, in addition to a license fee and annual report fee, in order tocover the costs of implementation and enforcementofthisSectionandR.S.22:1641through1657,1851through1864,and 1961 through 1995 any portion of this Title pertaining to pharmacy benefit management, including fees to cover the cost of all of the following:
* * * §1867.1 PBM duty;
compensation;
audits;
contract and other requirements A.
PBM Duty (1) Any pharmacy benefit manager doing business in this state shall act solely for the benefit of the health insurance issuers and health plans for which it provides pharmacy benefit management services and for the enrollees of the plans.
(2)Nopharmacybenefitmanager,subsidiary,parent,oraffiliateofsuch pharmacy benefit manager, either directly or indirectly, shall engage in any activity which increases the cost of prescription drugs to health insurance issuers, health plans, or enrollees;
restricts or impairs access to prescription drugs exceptas directly required by the design of the health plan;
or otherwise interfereswiththeobligationofthepharmacybenefitmanagertoactinthebest interest of health insurance issuers, health plans, and enrollees.
(3) A pharmacy benefit manager shall not:
(a) Obtain a rebate,or any other incentive or inducement including but not limited to discounts, on a name brand drug in exchange for not placing other name brand drugs, biosimilars, generic drugs, or any other drug in the same class of drugs on the PBM formulary, unless returned to the health Page 7 of 19 Coding:
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SB NO.
387 ENROLLED insurance issuer or plan sponsor.
(b) Design a prescription drug formulary to favor a certain branded pharmaceutical or biologic over a therapeutically equivalent generic or biosimilar, unless the branded pharmaceutical or biologic has a lower net acquisitioncostandthatlowercostisreflectedinalowerout-of-pocketexpense for consumers or lower premiums for enrollees.
(c) Use its formulary to effectively ban the use of certain pharmacies by an insured.
(4) Notwithstanding any other provision of law to the contrary, upon a determinationthatapharmacybenefitmanagerhasviolatedaprovisionofthis Subsection, the commissioner may impose a fine in the amount of the greater of the cost to the health insurance issuer, health plan, or enrollees or the enrichment to the pharmacy benefit manager and any subsidiaries, parent, or affiliatesthereof,plusanadditionalfineoftwenty-fivethousanddollarsforeach and every act or violation, with no aggregate penalty maximum.
B.
PBM Compensation (1)Apharmacybenefitmanagerorgrouppurchasingorganizationmay negotiate but shall not retain rebates and fees.
All manufacturer rebates, whetheraccruedtoapharmacybenefitmanager,apharmacybenefitmanager's affiliated group purchasing organization, or any other pharmacy benefit manager owned or affiliated entity shall be passed through to the pharmacy benefit manager's healthcare plan sponsor client as described in this Section.
(2) A pharmacy benefit manager may earn income only from the following sources:
(a) The assessment of a flat dollar service fee charged on a per-person per-month or a per-prescription or per-event basis which shall cover all of the pharmacy benefit manager's administrative, clinical, print, electronic, and related costs for the provision of prescription benefit management services to a client health benefit plan.
The flat dollar service fee may vary among a pharmacybenefitmanager'sclientsbasedonthenumberofhealthbenefitplan Page 8 of 19 Coding:
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SB NO.
387 ENROLLED participants and clinical and administrative servicesprovided, and shall be set forth in a written agreement between the parties.
(b) A flat dollar performance bonus payment, which may be paid by a client health benefit plan to a pharmacy benefit manager for meeting specified benchmarksinreducingtheclienthealthbenefitplan'saggregatedoveralldrug spending over a specific period of time.
A flat dollar performance bonus payment shall be set forth in a written agreement between the parties.
(3) Pharmacy benefit management fees charged by or paid to a pharmacy benefit manager from a health insurance issuer or health plan shall not be directly or indirectly based or contingent upon any of the following:
(a) The acquisition cost or any other price metric of a drug.
(b) The amount of savings, rebates, or other fees charged, realized, or collected by or generated based on the activity of the pharmacy benefit manager.
(c) The amount of premiums, deductibles, or other cost-sharing or fees charged, realized, or collectedby the pharmacy benefit manager frompatients or other persons on behalf of a patient.
(4)(a) A pharmacy benefit manager shall not earn any income based directlyonprescriptiondruglistprices,acquisitioncost,averagewholesalecost, or any other metric for prescription drug pricing or fulfillment at any stage in thedrugsupply chain,including butnot limitedtoprescriptiondrugmarkups, up-charging,spreadpricingofanykind,manufacturer-derivedrevenuesofany sort, which shall include but not be limited to price protection, group purchasingorganizationretainedrebatesorfeesofanykind,rebateaggregator administrativeoranyotherfeeschargedorcollected,couponcompensationand patientassistancecompensationfees,retaineddiscountsandrebates,andother manufacturer payments, and any other arrangements on price of prescription drugs.
(b) Any prohibited pharmacy benefitmanager income that a pharmacy manager may receive during the course of a pharmacy benefit manager's Page 9 of 19 Coding:
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SB NO.
387 ENROLLED operations in service of its Louisiana client health plans shall be considered prohibited incomethatthe pharmacy benefit managershall pass through in its entiretytothepharmacybenefitmanager'sLouisianahealthbenefitplanclients on a quarterly basis.
(5) Annually by December thirty-first, each pharmacy benefit manager operating in the state shall certify to the commissioner that it has fully and completely complied with the requirements of this Subsection throughout the prior calendar year.
The certification shall be signed by the chief executive officer or chief financial officer of the pharmacy benefit manager.
C.
PBM Audits (1) The commissioner and any health insurance issuer or health plan contracted with a pharmacy benefit manager holding a license issued by the commissionermayauditthepharmacybenefitmanageroncepercalendaryear.
This audit right is in addition to, and shall not be construed to limit, any other auditrightsauthorizedbylaworcontract.Thecommissionermayalsoexamine the books or records of any entity in a pharmacy benefit manager's corporate vertical structure, including but not limited to the insurer, group purchasing organization, manufacturer, wholesale distributor, special or mail order pharmacy, retail or long-term care pharmacy, and provider.
As part of any audit, the commissioner, health insurance issuer, or health plan may request information including but not limited to any of the following:
(a) All reimbursementpaid toretailpharmacies,on aclaim level, for all customersofthepharmacybenefitmanagerinthestate,includingdrug-specific reimbursement, dispensing fees, all rebates, other fees, ancillary charges, clawbacks, or adjustments to reimbursement.
(b) Any difference in reimbursement paid to affiliated pharmacies and unaffiliated pharmacies, including differences in reimbursed ingredient costs and dispensing fees.
(c)Historicalclaimsdataincludingingredientcost,quantity,dispensing fee, sales tax, usual and customary price, channel such as mail or retail, health Page 10 of 19 Coding:
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SB NO.
387 ENROLLED insurance issuer or health plan paid amount, days' supply, the amount paid by thecoveredindividual, formularytier,acquisition cost,andanyadministrative fee associated with the claim, as applicable.
(d) Aggregate rebate amounts received directly or indirectly from manufacturers,including fromany otherentityaffiliated with orrelatedtothe pharmacy benefit manager that negotiates or contracts with manufacturers, such as group purchasing organizations and rebate aggregators, by calendar quarter.
(2) The pharmacy benefit manager shall provide information pursuant to Paragraph (1) of this Subsection no later than thirty days after its receipt of any request from the commissioner, health insurance issuer, or health plan.
(3) The commissioner may dictate the form in which the pharmacy benefit manager will provide information in response to an audit pursuant to Paragraph (1) of this Subsection.
(4) The pharmacy benefit manager shall certify that all information submitted to the commissioner or any health insurance issuer or health plan in accordance with this Subsection is accurate and complete in all material respects.
The certification shall be signed by the chief executiveofficer or chief financial officer of the pharmacy benefit manager.
(5)(a)The commissioner and any health insurance issuer or health plan contracted with a pharmacy benefit manager holding a license issued by the commissioner shall not directly or indirectly publish or otherwise disclose any confidential, proprietary information, including but not limited to any information that would reveal the identity of a specific health plan or manufacturer, the price charged for a specific drug or class of drugs, the amount of any rebates provided for a specific drug or class of drugs, or that wouldotherwisehavethepotentialtocompromisethefinancial,competitive,or proprietarynatureoftheinformation.Anysuchinformationshallbeprotected as confidential and proprietary information, and is not a public record and is exempt fromdisclosure pursuant tothePublicRecordsLaw,R.S.44:4.1etseq.
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SB NO.
387 ENROLLED The commissioner and any health insurance issuer or health plan contracted withapharmacybenefitmanagerholding alicenseissuedbythecommissioner shallimposetheconfidentialityprotectionsandrequirementsofthisParagraph on any agentor downstreamthird party that may receiveor have accesstothis information.
(b) Nothing in this Paragraph shall be construed to prohibit the commissionerfromdisclosinginformationtoaPrescriptionDrugAffordability Board established pursuant to this Title if such information is subject to the confidentiality protections applicable to that board.
D.
PBM Contract and Other Requirements (1)Apharmacybenefitmanagercontractwithahealthinsuranceissuer orhealthplanenteredinto,amended,extended,orrenewedonorafterJanuary 1, 2027, shall do both of the following:
(a) Specify all forms of revenue, including pharmacy benefit managementfees,tobepaidbythehealthinsuranceissuerorhealthplantothe pharmacy benefit manager.
(b)Acknowledgethatspreadpricingisnotpermittedinaccordancewith R.S.
22:1867.
E.(1) In addition to any other penalty authorized by law, a violation of this Section shall be punishable by the commissioner through a civil monetary penaltyoftwenty-fivethousanddollarsforeachandeveryactorviolation,with no aggregate penalty maximum.
(2) If a violation for which the commissioner has imposed a fine in accordancewith this Subsection is not correctedwithin thirtydays afternotice oftheviolationisreceivedbythepharmacybenefitmanager,thecommissioner shall suspend or revoke the pharmacy benefit manager's license in accordance with R.S.
49:977.3.
F.
In implementing the requirements of this Section, the state shall regulate a pharmacy benefit manager or health insurance issuer only to the extent permissible under applicable law.
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SB NO.
387 ENROLLED G.
The provisions of this Subpart shall apply only to the extent not preempted or otherwise prohibited by federal law.
To the extent such conflict exists,thevalidityoftheremainderofthisSubpartandtheapplicabilitythereof to any other entity, person, or circumstance shall not be affected.
H.
Pharmacy Technology and Third Party Data Sharing (1)Apharmacybenefitmanager,oranyaffiliate,subsidiary,oragentof apharmacybenefitmanager,shallnotdirectlyorindirectlyprohibitorrestrict a pharmacist or pharmacy from offering, directly or through a third party, services or products to increase transparency, access, and affordability of prescriptiondrugs forpatients.
Such servicesand products include butarenot limited to:
(a) Simplified payment processes, electronic payments, or payment plans.
(b) Adherence support services or communications.
(c) Information regarding patient out-of-pocket costs or alternative medication options.
(d) Electronic transactions that allow the pharmacist or pharmacy to provide patients with price and benefits transparency.
(e) Sharing claims data or other healthcare transaction data of patients with thepatient,thepatient's healthcareproviders,abusiness associate as that termis definedin45CFR160.103,orany third partyauthorizedby thepatient at the time the pharmacist or pharmacy runs the claim or other electronic transaction or at any time thereafter.
(f) Electronic transactions that allow the pharmacist or pharmacy to provide patients with prior authorization support to enable access to the patient's prescription drug.
(g) Any lawful copayment assistance or other out-of-pocket support to patients to lower the costs of their prescription drugs.
(2)Apharmacybenefitmanager,oranyaffiliate,subsidiary,oragentof a pharmacy benefit manager, shall not directly or indirectly:
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SB NO.
387 ENROLLED (a) Audit, investigate, terminate, or threaten to terminate a pharmacist or pharmacy from the pharmacy benefit manager's network as a result of the pharmacist or pharmacy engaging in any activity described in or allowed by Paragraph (1) of this Subsection.
(b)Reduce,rescind,orotherwiseclawbackanyreimbursementpayment in whole or in part to a pharmacist or pharmacy for a prescriptions drug's ingredient cost or dispensing fee as a result of the pharmacist or pharmacy engaging in any activity described in or allowed by Paragraph (1) of this Subsection.
(c) Discriminate against or otherwise penalize a pharmacist or pharmacy, including but not limited to decreasing any reimbursementratesor by reclassifying the pharmacist or pharmacy's class of trade as a result of the pharmacist or pharmacy engaging in any activity described in or allowed by Paragraph (1) of this Subsection.
(3) Nothing in this Subsection shall be construed to modify or limit the application of R.S.
40:2870(A)(3)to a pharmacy benefit manager'shandling of beneficiarypersonalhealthcareorcontactinformation.Apharmacy'ssharing ofclaimsdataorotherhealthcaretransactiondatawithabusiness associate,as that term is defined in 45 CFR 160.103, in compliance with the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, shall not constitute a pharmacy benefit manager buying, selling, transferring, or providing personal health care or contact information within the meaning of R.S.
40:2870(A)(3).
(4) Any contract provision between a pharmacy benefit manager and a pharmacist or pharmacy that conflicts with this Subsection shall be severable from the contract and considered void and unenforceable in this state.
(5) A violation of this Subsection is subject to the penalties provided in this Section.
* * * §1868.2.
Pharmacy benefit manager formularies Page 14 of 19 Coding:
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SB NO.
387 ENROLLED A.
As used in this Section, the following terms have the following meanings:
(1) "Affiliated manufacturer" means a drug or biological product manufacturer that, either directly or indirectly through one or more intermediaries, meets one or more of the following criteria:
(a)Has an investment orownership interestgreaterthan fivepercentin a pharmacy benefit manager.
(b) Shares common ownership with a pharmacy benefit manager.
(c) Has an investor or a holder of an ownership interest in a pharmacy benefit manager.
(2) "Biological product" has the same meaning as in the Public Health Service Act, 42 U.S.C.
262.
(3) "Biosimilar" has the same meaning as in the Public Health Service Act, 42 U.S.C.
262.
(4) "Interchangeable" has the same meaning as in the Public Health Service Act, 42 U.S.C.
262.
B.(1) A pharmacy benefit manager revising the formulary of covered prescription drugs at the beginning of a plan year shall provide a sixty-day continuity-of-care period in which the covered prescription drug that is being revisedfromtheformularycontinuestobeprovidedinthesameformularytier and cost-sharing structure for the period of sixty days.
(2)Thesixty-daycontinuity-of-careperiodcommencesuponnotification to the insured by the insurer.
(3) This Subsection does not apply if any of the following have occurred regarding the covered prescription drug:
(a) The prescription drug has been made available over the counter by the United States Food and Drug Administration and has entered the commercial market as such.
(b) The prescription drug has been removed or withdrawn from the commercial market by the manufacturer.
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SB NO.
387 ENROLLED (c) The prescription drug is subject to an involuntary recall by state or federal authorities and is no longer available on the commercial market.
C.
A pharmacy benefit manager shall not require an insured to receive adrugorbiologicalproductthatismanufacturedbyanaffiliatedmanufacturer whenthereisanavailablegenericallyequivalentdrug,oranavailablebiological product that is biosimilar to and interchangeable for the prescribed biological product.
D.
A pharmacy benefit manager shall not require an insured to receive a more expensive name brand drug when less expensive name brand drugs, biosimilars, generic drugs, or any other drug in the same class of drugs are available.
E.Otherthanatthetimeofcoveragerenewal,whileaninsuredistaking a prescription drug a pharmacy benefit manager shall not do any of the following:
(1) Remove the prescription drug from its list of covered drugs during the policy year unless any of the following have occurred:
(a) The United States Food and Drug Administration has issued a statement about the drug which calls into question the clinical safety of the drug.
(b) The manufacturer of the drug has notified the United States Food and Drug Administration of a manufacturing discontinuance or potential discontinuance of the drug as required by the Federal Food, Drug, and Cosmetic Act, 21 U.S.C.
356c.
(c)The drug has beenapproved andmadeavailableoverthecounterby the United States Food and Drug Administration and entered the commercial market as such.
(2) Reclassify the drug to a more restrictive drug tier or increase the amount that an insured must pay for a copayment, coinsurance, or deductible for prescription drug benefits, or reclassify the drug to a higher cost-sharing tier during the policy year.
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SB NO.
387 ENROLLED F.ThisSectiondoesnotprohibittheadditionofprescriptiondrugstothe formulary during the policy year.
G.
The provisions of this Subpart shall apply only to the extent not preempted or otherwise prohibited by federal law.
To the extent such conflict exists,thevalidityoftheremainderofthisSubpartandtheapplicabilitythereof to any other entity, person, or circumstance shall not be affected.
Section 2.
R.S.
39:1600.1(A), the introductory paragraph of 1600.1(D), and 1600.1(D)(6) are herebyamended and reenacted to read as follows:
§1600.1.
Procurement of pharmacybenefit manager services by reverse auction A.(1) This section shall be known and may be cited as the "Louisiana Competitive Pharmacy Benefit Managers Act".
(2)ItisrecommendedtoconducttheinitialPBMreverseauctionnolater thanJuly1,2028.Termsofanycontractforpharmacybenefitservicesawarded through the initial reverse auction process may become effective at commencement of the new plan year beginning January 1, 2029.
(3) It is recommended that PBM reverse auctions be conducted in accordance with the provisions of this Chapter at a frequency of no less than once every five years.
* * * D.
Contracts It is recommended that contracts for pharmacy benefit managerservicesobtainedthroughreverseauctionshall complywith thefollowing:
* * * (6)(a) With technical assistance and support provided by the technology platform provider, the division of administration shall specify the terms of the participantbiddingagreementwhichshallnotbemodifiedexceptbyspecificconsent of the division of administration.
(b) It is recommended that the participant bidding agreement require qualified bidders in the PBM reverse auction process, both full service PBMs and carve-out service providers, to comply with the terms and provisions of all PBM regulations in Title 22 of the Louisiana Revised Statutes of 1950.
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387 ENROLLED (c) It is recommended that qualified specialty carve-out prescription drugserviceproviderscompetewithfullservicePBMsonthebasisofpriceand any other appropriate criteria for award of a specialty drug contract over multiple rounds of dynamically competitive reverse auction bidding.
(d)Itisrecommendedthatqualifiedgenericcarve-outprescriptiondrug service providers compete with full service PBMs on the basis of price and any other appropriate criteria for award of a generic drug contract over multiple rounds of dynamically competitive reverse auction bidding.
(e)The PBMreverseauction processmayresultin award of multiple or hybrid contracts to full service and carve-out prescription service providers if such award is determined to be of higher value to the state.
* * * Section 3.
R.S.
44:4.1(B)(11) is hereby amended and reenacted to read as follows:
§4.1.
Exceptions * * * B.Thelegislaturefurtherrecognizesthatthereexistexceptions,exemptions, and limitations to the laws pertaining to public records throughout the revised statutesandcodesofthisstate.Therefore,thefollowingexceptions,exemptions,and limitations are hereby continued in effect by incorporation into this Chapter by citation:
* * * (11) R.S.
22:2, 14, 31, 42.1, 88, 244, 263, 265, 461, 550.7, 550.22, 550.29, 550.30, 571, 572, 572.1, 572.2, 574, 601.3, 618, 639, 691.4, 691.5, 691.6, 691.7, 691.8,691.9,691.9.1,691.10,691.38,691.56,732,752,753,771,834,972(D),976, 1008, 1019.2, 1203, 1460, 1464, 1466, 1483.1, 1488, 1546, 1559, 1566(D), 1644, 1656, 1657.1, 1660.7, 1723, 1796, 1801, 1808.3, 1867.1, 1869, 1927, 1929, 1983, 1984, 2036, 2045, 2056, 2085, 2091, 2293, 2303, 2508 * * * Section 4.
R.S.
22:1868.1 and Section 5 of Act 474 of the 2025 Regular Session are hereby repealed in their entirety.
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387 ENROLLED Section 5.
Sections 1 through 4 and 6 through 8 of this Act shall take effect and become enforceable only if Section 4 of the Act which originated as Senate Bill No.
401 of the 2026 Regular Session of the Legislature is enacted and becomes effective.
Section 6.
The provisions of this Act amending and reenacting R.S.
22:1856.1 and 1865 and enacting 1867.1(C) and 1867.1(E) and (F), shall become effective upon signature of the governor or, if not signed by the governor, upon expiration of the time for bills to become law without signature bythe governor, as provided byArticle III, Section 18 of the Constitution of Louisiana.
If vetoed by the governor and subsequently approved by the legislature, these provisions of this Act shall become effective on the day following such approval.
Section 7.
The provisions of this Act amending and reenacting R.S.
22:1863 and enacting 1867.1(A)(1), (2), and (4) and (D) shall become effective on January 1, 2027.
Section8.TheprovisionsofthisActamendingandreenactingR.S.39:1600.1(A)and the introductory paragraph of 1600.1(D) and 1600.1(D)(6) and enacting 1867.1(A)(3) and (B) and 1868.2 shall become effective on January 1, 2028.
PRESIDENT OF THE SENATE SPEAKER OF THE HOUSE OF REPRESENTATIVES GOVERNOR OF THE STATE OF LOUISIANA APPROVED:
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