The bill, introduced by Representative Dewitt, amends and reenacts several provisions related to pharmacy benefit managers (PBMs) and their reimbursement practices for local pharmacies in Louisiana. Key changes include the definition of "acquisition cost," which is now based on the actual amount a pharmacy pays for a drug, and the introduction of a "professional dispensing fee" that reflects the costs incurred by pharmacists during the dispensing process. The bill also establishes a reimbursement formula that must use either the National Average Drug Acquisition Cost (NADAC) or, if NADAC is unavailable, the wholesale acquisition cost. Additionally, it mandates that PBMs bear all costs associated with professional dispensing fees, prohibiting these costs from being passed on to plans, members, pharmacies, or pharmacists.

Furthermore, the bill outlines an appeals process for pharmacies to contest claim payment errors, ensuring that if a pharmacy's reimbursement is less than its acquisition cost, it can appeal for additional payment. It also allows health insurance issuers or PBMs to implement optional copayment assistance benefit plans. The provisions of the bill are set to be applied retroactively to January 1, 2026, and certain existing statutory provisions are repealed to streamline the law. Overall, the bill aims to enhance transparency and fairness in pharmacy reimbursements while protecting local pharmacies from financial losses due to inadequate reimbursements.

Statutes affected:
HB1236 Original:
HB1236 Engrossed:
HB1236 Reengrossed: 22:1868(B), 22:1868(B)(2)