ENROLLEDSCAHB1236 3275 3319 SENATE COMMITTEE AMENDMENTS Regular Session HOUSEAmendments BILLproposed NO.bySenate Committee on Insurance to Reengrossed House Bill No.

1236by (SubstituteRepresentative forDewitt HouseAMENDMENT BillNO. No.

8661 byOn Representativepage Dewitt)1, BYline REPRESENTATIVES2, DEWITTafter"(1),"delete ANDthe ECHOLSremainderof ANthe ACTline ToamendandreenactR.S.22:1868(B)(introductoryparagraph),(1),and(4)and(C)(1),(2),and insert "and (4) and (3)(c)(C)(1), (2), and (d),(3)(c) toand enact(d)," R.S.AMENDMENT NO.

22:1868(B)(5),2 (D),On andpage (E),1, andline to3, repealafter R.S."(E)," delete "and 1868.2," AMENDMENT NO.

22:1868(B)(2),3 relativeOn topage pharmacybenefit1, managers;line 4, after "22:1868(B)(2)" delete "and (C)(2)" AMENDMENT NO.

to4 provideOn forpage definitions;1, line 7, after "application;" delete the remainder of the line AMENDMENT NO.

to5 provideOn forpage pharmacy1, reimbursements;at the beginning of line 8, delete "of copayment of assistance benefits;" AMENDMENT NO.

to6 prohibitOnpage1,line10,after"(1),"deletetheremainderofthelineandinsert"and(4)and(C)(1), certain(2), reimbursementand cost(3)(c) assignments;and (d) are" AMENDMENT NO.

to7 provideOn forpage certain1, prohibitions;line 11, after "(E)" delete "and 1868.2" AMENDMENT NO.

to8 provideOn forpage an2, effectiveline date;5, after "cost or" insert a comma "," AMENDMENT NO.

to9 provideOn forpage retroactive2, application;line 24, after "counseling," insert "and" AMENDMENT NO.

and10 toOn providepage for3, relateddelete matters.lines 12 through 14 in their entirety and insert the following:

Be"(2)(a) itAdopt enacteda byreimbursement formula using an adjustment factor that, based on claims experience data available to the Legislaturepharmacy benefit manager, is reasonablyexpected to resultin a claim payment errorrate of Louisiana:no more than two percent per drug as identified by its national drug code.

Section1.a professional dispensing fee that is an amount not less than the professional dispensing fee established by the Louisiana Department of Health for the Louisiana Medicaid program." AMENDMENT NO.

R.S.22:1868(B)(introductoryparagraph),(1),and(4)and(C)(1),(2),and11 (3)(c)On andpage (d)3, areline hereby16, amendedafter and"pharmacists" reenacteddelete andthe R.S.comma "," Page 1 of 2 SCAHB1236 3275 3319 AMENDMENT NO.

22:1868(B)(5),12 (D),On page 3, delete lines 20 through 28 and (E)on arepage hereby4, enacteddelete tolines read1 asand follows:2 and insert a set of asterisks "* * *" AMENDMENT NO.

§1868.13 On page 4, delete lines 11 through 24 and insert a set of aste*isks "*" AMENDMENT NO.

Localpharmacyreimbursement;14 On page 5, delete lines 1 through 5 AMENDMENT NO.

NationalAverageDrugAcquisition15 Costs;On page 5, line 6, after " R.S.

appeals22:1868(B)(2)" *delete *the *remainder B.of the line and insert "is hereby repealed in its entirety." Page 2 of 2

For purposes of this Section, the following definitions shall apply:

(1)(a) "Acquisition cost" means the set of National Average Drug Acquisition Costs, "NADAC", as calculated by the Centers for Medicare and Medicaid Services and reflected in the most recentlyreleased public file.

means the amount a local pharmacyactuallypays to purchase a prescription drug or device, as evidenced by a wholesaler or manufacturer invoice, and shall not be less than the National Average Drug Acquisition Cost or NADAC published by the Centers for Medicare and Medicaid Services on the date the prescription drugis dispensed.

(b) FordrugsforwhichnoNADACrateispublished,acquisitioncostmeans the local pharmacy's documented invoice cost or, if no invoice is available, the wholesale acquisition cost as published in a nationally recognized drug pricing compendium on the date of dispensing.

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1236 ENROLLED (c) "Acquisition cost" is not defined byor determined at the sole discretion of a pharmacybenefit manager or third-party administrator.

* * * (4) "Reimbursement formula" means a prescription drug reimbursement calculation involving an ingredient price, calculated based on a prescription drug pricing benchmark plus an adjustment factor, and a professional dispensing fee.

(5) "Professionaldispensingfee"meansafeethatmeetsallofthefollowing:

(a) Incurred at the point of sale or serviceand pays for costs in excess of the ingredient cost of a covered outpatient drug each time a covered outpatient drug is dispensed.

(b) Includes only pharmacy costs associated with ensuring that possession of the appropriatecoveredoutpatient drugis transferredto a beneficiary.

Pharmacy costs include but are not limited to reasonable costs associated with a pharmacist's time in checking the computer for information about an individual's coverage, performing drug utilization review and preferred drug list review activities, measurement or mixing of the covered outpatient drug, filling the container, beneficiary counseling, and physically providing the completed prescription to the beneficiary, delivery, special packaging, and overhead associated with maintaining the facility and equipment necessaryto operate the pharmacy.

(c) Does not include administrative costs incurred by the state in the operation of the covered outpatient drug benefit including systems costs for interfacing with pharmacies.

C.

Notwithstanding any provision of law to the contrary, effective January 1,2026,apharmacybenefitmanagershallmeetallofthefollowingrequirementsfor claims submitted by any local pharmacy to a pharmacy benefit manager administering claims on behalf of a health plan, except for the Office of Group Benefits:

(1) AdoptareimbursementformulausingeitherNADACastheprescription drug pricing benchmark or, if NADAC is not available, the wholesale acquisition cost.or,withpriorwrittenapprovalbythecommissioner,analternativeprescription Page 2 of 4 CODING:

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1236 ENROLLED drugpricingbenchmarkthatresultsinclaimpaymenterrorsthatarebothcomparable to or less than NADAC in terms of frequencyand smaller than NADAC in terms of magnitude.