LEGISLATIVE FISCAL OFFICE
Fiscal Note
Fiscal Note On: SB 94 SLS 21RS 260
Bill Text Version: ENROLLED
Opp. Chamb. Action:
Proposed Amd.:
Sub. Bill For.:
Date: June 6, 2021 2:02 PM Author: HARRIS, JIMMY
Dept./Agy.: Insurance
Subject: Insurance Cost-Sharing Practices Analyst: Patrice Thomas
INSURERS EN NO IMPACT See Note Page 1 of 1
Provides relative to insurance cost-sharing practices. (gov sig)
Proposed law expands the definition of a Pharmacy Benefit Manager (PBM) to include either directly or through an
intermediary manager, and the management or administration of a benefit plan may include review, processing of drug prior
authorization requests, adjudication of appeals and grievances related to the prescription drug benefit, contracting with
network pharmacies, and controlling the cost of covered prescription drugs. Proposed law provides for fairness in enrollee
cost-sharing and provides for definitions. Proposed law provides that when calculating an enrollee's contribution to any
applicable cost-sharing requirement, a health insurance issuer shall include any cost-sharing amounts paid by the enrollee or
on behalf of the enrollee by another person. Proposed law provides the Commissioner of Insurance when implementing the
proposed law shall regulate a health insurance issuer only to the extent permissible under applicable law.
EXPENDITURES 2021-22 2022-23 2023-24 2024-25 2025-26 5 -YEAR TOTAL
State Gen. Fd. $0 $0 $0 $0 $0 $0
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other $0 $0 $0 $0 $0 $0
Federal Funds $0 $0 $0 $0 $0 $0
Local Funds $0 $0 $0 $0 $0 $0
Annual Total $0 $0 $0 $0 $0 $0
REVENUES 2021-22 2022-23 2023-24 2024-25 2025-26 5 -YEAR TOTAL
State Gen. Fd. $0 $0 $0 $0 $0 $0
Agy. Self-Gen. $0 $0 $0 $0 $0 $0
Ded./Other $0 $0 $0 $0 $0 $0
Federal Funds $0 $0 $0 $0 $0 $0
Local Funds $0 $0 $0 $0 $0 $0
Annual Total $0 $0 $0 $0 $0 $0
EXPENDITURE EXPLANATION
There is no anticipated direct material effect on governmental expenditures as a result of this measure. The proposed law
provides that health insurance issuers (including their Pharmacy Benefit Manager) must include any cost-sharing amounts
paid by the enrollee or on behalf of the enrollee when calculating an enrollee’s contribution. The proposed law requires the
Commissioner of the LA Department of Insurance (LDI) to implement provisions of cost-sharing practices of this measure.
LDI reports that it is capable of handling any workload impact arising from the proposed law with existing budgetary and
personnel resources.
The Office of Group Benefits (OGB) reports that they do not use the cost-sharing practices being prohibited under this
measure. Under OGB’s five self-insured health plans, drug manufacturer coupons are fully counted towards the members'
cost-sharing obligations - the deductible and the maximum out-of-pocket limits.
REVENUE EXPLANATION
There is no anticipated direct material effect on governmental revenues as a result of this measure.
Senate Dual Referral Rules House
13.5.1 >= $100,000 Annual Fiscal Cost {S & H} 6.8(F)(1) >= $100,000 SGF Fiscal Cost {H & S}
Alan M. Boxberger
13.5.2 >= $500,000 Annual Tax or Fee 6.8(G) >= $500,000 Tax or Fee Increase
Change {S & H} or a Net Fee Decrease {S} Staff Director


Statutes affected:
SB94 Original: 22:1641(8)
SB94 Engrossed: 22:1641(8)
SB94 Enrolled: 22:1641(8)
SB94 Act : 22:1641(8)