Senate Bill No. 173, introduced by Senator Jackson-Andrews, aims to amend the reimbursement rates paid by Pharmacy Benefit Managers (PBMs) to pharmacies and pharmacists in Louisiana, effective August 1, 2025. The bill stipulates that no PBM shall reimburse a pharmacy or pharmacist an amount less than the acquisition cost for covered drugs, devices, or services, with "acquisition cost" defined as the actual price reported on an invoice from a supplier or wholesaler for drugs and a professional dispensing fee for services. Additionally, the bill outlines that these provisions apply only to contracted pharmacists or pharmacies with limited ownership interests in pharmaceutical wholesale organizations.

The bill also enhances the appeals process for pharmacies contesting reimbursement rates set by PBMs. It mandates that PBMs provide necessary information to resolve complaints and allows for appeals to be filed within 15 days of reimbursement. If an appeal is granted, the PBM must permit the appealing pharmacy and similarly situated pharmacies to reverse and resubmit claims for retroactive adjustments, notify affected pharmacies of these changes, and make necessary price adjustments in the next payment cycle. Overall, the bill seeks to ensure fair reimbursement practices and improve the administrative process for pharmacies in Louisiana.

Statutes affected:
SB173 Original: 22:1860(E), 22:1865(E)