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. It defines "acquisition cost" as the actual price reported by the pharmacy on an invoice from a supplier for drugs or devices, and for services, it refers to the professional dispensing fee established by the Louisiana Department of Health for the Medicaid Program.

Additionally, the bill outlines a process for pharmacies and pharmacists to appeal reimbursement rates set by PBMs. It mandates that PBMs provide necessary information to resolve complaints and allows 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 payment adjustments. The bill also requires PBMs to notify affected pharmacies of any changes and to make retroactive price adjustments in the next payment cycle.

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