Bill > SB173

This bill amends Louisiana law to establish new regulations for Pharmacy Benefit Managers (PBMs), which are companies that manage prescription drug benefits for health insurers. Effective January 1, 2025, the bill requires PBMs to reimburse pharmacies at least their actual acquisition cost for drugs, devices, or services. The bill defines "acquisition cost" as the actual price paid by a pharmacy for a drug or device, as shown on an invoice, or for services, the professional dispensing fee established by Louisiana Medicaid. Additionally, the bill enhances the appeals process for pharmacies challenging reimbursement rates. PBMs must now report drugs with established maximum allowable costs, permit appeals within at least 15 days of reimbursement, and if an appeal is granted, must retroactively adjust payments for the appealing pharmacy and similarly situated pharmacies. Pharmacies must not own more than five shares or a five percent interest in a pharmaceutical wholesale group to be eligible for these protections. The goal of the bill appears to be ensuring fair reimbursement rates for pharmacies and increasing transparency in the drug reimbursement process.

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https://www.legis.la.gov/legis/BillInfo.aspx?s=25rs&b=SB173&sbi=y