Mills (SB 410) Act No. 391
New 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
New 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.
New 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.
New 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 new law.
Requires the pharmacy benefits manager to respond to a challenge within seven business
days after receipt of a challenge.
New 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.
New law requires a pharmacy benefits manager to provide the challenging pharmacy or
pharmacist the NDC number if an appeal is denied.
New law deems a violation of new 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)