HLS 10RS-1284 ORIGINAL
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
Regular Session, 2010
HOUSE BILL NO. 337
BY REPRESENTATIVE LEBAS
INSURANCE/HEALTH-ACCID: Prohibits health insurance issuers from unilaterally
determining fees on pharmacy claims
AN ACT1
To enact R.S. 22:1856(F), relative to pharmacy claims; to provide relative to determination2
of fees on such claims; and to provide for related matters.3
Be it enacted by the Legislature of Louisiana:4
Section 1. R.S. 22:1856(F) is hereby enacted to read as follows: 5
ยง1856. Thirty-day payment standard; limitations on claim filing and audits;6
remittance advice7
* * *8
F. No health insurance issuer or its agent shall unilaterally determine the9
amount of any fee cited by Subsection C of this Section or any other fee on each10
claim but shall decide that amount in conjunction with the affected pharmacist or11
pharmacy.12
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
LeBas HB No. 337
Abstract: Provides relative to determination of fees on pharmacy claims.
Present law requires that each remittance advice generated by a health insurance issuer or
its agent to a pharmacist or his agent or pharmacy or its agent have payment attached and
include the following information, clearly identified and totaled for each pharmacy claim
listed: HLS 10RS-1284 ORIGINAL
HB NO. 337
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.
(1)Unique enrollee or insured identification number.
(2)Patient claim number or patient account number.
(3)Date that the prescription was filled.
(4)National Drug Code.
(5)Quantity dispensed.
(6)Price submitted to the health insurance issuer.
(7)Amount paid by the health insurance issuer.
(8)Dispensing fee.
(9)Provider fee.
(10)Taxes.
(11)Enrollee or insured liability, specifying any coinsurance, deductible, copayment, or
noncovered amount.
(12)Any amount adjusted by the health insurance issuer or its contractor and the reason
for adjustment.
(13)Any other deduction or charge, listed separately.
(14)A toll-free telephone number for assistance with the remittance advice.
Proposed law prohibits any health insurance issuer or its agent from unilaterally determining
the amount of any fee cited by present law or any other fee on each pharmacy claim.
Specifically requires such determination to be made in conjunction with the affected
pharmacist or pharmacy.
(Adds R.S. 22:1856(F))