Senate Bill No. SLS 26RS-518 seeks to enhance the regulation of pharmacy benefit managers (PBMs) in Louisiana by establishing a fiduciary duty for PBMs to act in the best interests of enrollees, health plans, and providers. The bill mandates transparency in PBM operations, requiring them to provide clear information regarding pricing and conflicts of interest. It prohibits practices that could disadvantage consumers, such as favoring specific drugs or pharmacies without justification. Additionally, the legislation introduces a private cause of action for individuals harmed by violations of these provisions, along with civil monetary penalties for non-compliance.

The bill also outlines specific operational changes, including limiting audits to once per year for each pharmacy and allowing consolidated appeals for similar claims. It prohibits PBMs from retaining rebates and fees, ensuring that any prohibited income is passed through to health benefit plan clients. Furthermore, it requires PBM contracts to specify all forms of revenue and disallows spread pricing. The legislation includes new definitions relevant to PBM operations and clarifies that its provisions do not apply to health benefit plans regulated under the Employee Retirement Income Security Act (ERISA) of 1974. The effective date for these changes is set for January 1, 2027.

Statutes affected:
SB387 Original: 44:1(B)(11)
SB387 Engrossed: 22:1(B)(2), 22:1865(A), 44:1(B)(11)
SB387 Reengrossed: 22:1(B)(2), 22:1865(A), 44:1(B)(11)