Senate Bill No. by Senator Edmonds aims to amend and reenact certain provisions related to the audits of pharmacy records within Louisiana's insurance laws. The bill expands the definition of "health insurance issuer" to include agents, thereby broadening the scope of entities subject to these regulations. It introduces the concept of "other reviews" of pharmacy records alongside audits, while also clarifying that audits can be conducted to determine the correctness of claims filed by pharmacies. Notably, the bill removes the requirement for pharmacies to submit prescription copies and additional documentation unrelated to the specific claims under review.

Furthermore, the bill outlines enforcement measures by the commissioner of insurance, who is empowered to take action against managed care companies, insurers, or third-party payers if violations are found during investigations, either initiated by the commissioner or in response to complaints. This includes the potential suspension or revocation of licenses for non-compliance. The proposed changes are set to take effect on August 1, 2024, and aim to enhance the oversight and accountability of pharmacy claims audits while protecting pharmacies from excessive documentation demands.

Statutes affected:
SB311 Original: 22:1852(7), 22:1(B), 22:1(B)(2)