The original instrument was prepared by Cheryl Horne. The following digest,
which does not constitute a part of the legislative instrument, was prepared by
Linda Nugent.
DIGEST
Mills (SB 410)
Proposed law provides for definitions of:
(1)Maximum Allowable Cost List
(2)National Drug Code (NDC)
(3)Pharmacist
(4)Pharmacist services
(5)Pharmacy
(6)Pharmacy benefits manager
(7)Pharmacy benefits plan or program
Proposed law allows a pharmacy benefits manager to use the NDC only when the following
conditions have been met:
(1)The prescription drug to which the NDC is assigned is listed as "A" or "B" rated in the
most recent version of the FDA's Orange Book.
(2)The prescription drug to which the NDC is assigned is available for purchase by
pharmacies in the state from national or regional wholesalers.
(3)The prescription drug to which the NDC is assigned is not considered obsolete.
Proposed law requires a pharmacy benefits manager to:
(1)Provide access to its Maximum Allowable Cost List.
(2)Update its Maximum Allowable Cost List on a timely basis.
(3)Provide a process for each pharmacy to review an update to the Maximum Allowable
Cost List.
Proposed law requires a pharmacy benefits manager to provide a reasonable administrative appeal procedure. Permits a pharmacy to file an appeal by following the appeal process in
proposed law. Requires the pharmacy benefits manager to respond to a challenge within seven
business days after receipt of a challenge.
Proposed law requires a pharmacy benefits manager to perform the following if an appeal is
upheld:
(1)Make the change in the Maximum Allowable Cost List.
(2)Permit the challenging pharmacy or pharmacist to reverse and rebill the claim.
(3)Make the change effective for each similarly situated pharmacy.
Proposed law requires a pharmacy benefits manager to provide the challenging pharmacy or
pharmacist the NDC number if an appeal is denied.
Proposed law deems a violation of proposed law to be an unfair or deceptive act and practice
pursuant to R.S. 22:1961 et seq.
Effective August 1, 2014.
(Adds R.S. 22:1863-1865)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original bill.
1. Permits a pharmacy to file an appeal within seven business days after the
applicable fill date by following the appeal process in proposed law.
2. Provides that a violation of proposed law shall be deemed an unfair or deceptive
act and practice pursuant to present law.
Senate Floor Amendments to engrossed bill
1. Technical amendments.