House Bill No. HLS 26RS-1084 seeks to enhance the regulation of pharmacy benefit managers (PBMs) in Louisiana by amending existing laws and introducing new provisions. The bill revises the definition of "pharmacy benefit manager" to include any entity managing pharmacy benefit services and mandates that PBMs reimburse local pharmacies at no less than the National Average Drug Acquisition Cost (NADAC) plus a dispensing fee. It also establishes an appeal process for pharmacies disputing reimbursement amounts that fall below their acquisition costs, ensuring they can seek additional payment. Furthermore, the bill limits PBMs' income sources to a flat service fee and performance bonuses, prohibiting revenue from drug pricing metrics or retained rebates, and requires transparency in fee structures.

In addition to these provisions, the bill mandates that PBM contracts with health benefit plans include disclosures of claims-level pricing data and pharmacy reimbursement amounts. It requires PBMs serving plans with a significant number of Louisiana participants to provide the commissioner with access to detailed claims-level pricing and reimbursement data. The procurement process for PBM services is revised to utilize a reverse auction format, allowing for multiple contract awards while ensuring compliance with regulations. A conflict-of-interest provision is also included to restrict certain consultants from participating in the selection process for the PBM reverse auction technology platform. The implementation of the bill is scheduled to begin on October 1, 2026.

Statutes affected:
HB938 Original: 22:1863(11), 39:1(D)(1), 39:1(D)(3)
HB938 Engrossed: 22:1863(11), 39:1(D)(1), 39:1(D)(3)
HB938 Reengrossed: 22:1863(11), 39:1(D)(1)