The bill, introduced by Representative Dewitt, amends existing laws regarding pharmacy benefit managers (PBMs) and their reimbursement practices for local pharmacies in Louisiana. It updates the definition of "acquisition cost" to reflect the actual amount a pharmacy pays for prescription drugs, as evidenced by invoices, and establishes that this cost cannot be determined solely by PBMs. Additionally, the bill introduces a new term, "professional dispensing fee," which outlines the costs associated with dispensing medications, ensuring that these fees are not passed on to health plans, members, or pharmacies.

Furthermore, the bill mandates that PBMs adopt specific reimbursement formulas based on either the National Average Drug Acquisition Cost (NADAC) or wholesale acquisition cost, and it requires them to implement an appeals process for pharmacies to contest claim payment errors. The legislation also prohibits PBMs from altering the out-of-pocket costs for consumers and allows the commissioner to request claims-level data to ensure compliance with these new regulations. The changes aim to enhance transparency and fairness in pharmacy reimbursements while protecting local pharmacies from underpayment.

Statutes affected:
HB1236 Original: