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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
Regular Session, 2014 ENROLLED
SENATE BILL NO. 410
BY SENATOR MILLS
AN ACT1
To enact Subpart C-1 of Part II of Chapter 6 of Title 22 of the Louisiana Revised Statutes2
of 1950, to be comprised of R.S. 22:1863 through 1865, relative to Maximum3
Allowable Cost Lists for prescription drugs; to provide with respect to definitions;4
to provide for the regulation of pharmacy benefit manager's maintenance and use of5
Maximum Allowable Cost Lists for prescription drugs; to provide with respect to an6
appeals process; and to provide for related matters.7
Be it enacted by the Legislature of Louisiana:8
Section 1. Subpart C-1 of Part II of Chapter 6 of Title 22 of the Louisiana Revised9
Statutes of 1950, comprised of R.S. 22:1863 through 1865, is hereby enacted to read as10
follows:11
Subpart C-1. PHARMACY BENEFIT MANAGER'S MAINTENANCE AND USE12
OF "MAXIMUM ALLOWABLE COST LISTS" FOR PRESCRIPTION DRUGS13
§1863. Definitions14
As used in this Subpart, the following definitions shall apply:15
(1) "Maximum Allowable Cost List" means a listing of the National Drug16
Code used by a pharmacy benefits manager setting the maximum allowable cost17
on which reimbursement to a pharmacy or pharmacist may be based.18
(2) "NDC" means the National Drug Code, a numerical identifier19
assigned to all prescription drugs.20
(3) "Pharmacist" means a licensed pharmacist as defined in R.S.21
22:1852(8).22
(4) "Pharmacist services" means products, goods, or services provided23
as a part of the practice of pharmacy as defined in R.S. 22:1852(9).24
(5) "Pharmacy" means any appropriately licensed place where25
prescription drugs are dispensed as defined in R.S. 22:1852(10).26
ACT No. 391 SB NO. 410 ENROLLED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
(6) "Pharmacy benefits manager" means an entity that administers or1
manages a pharmacy benefits plan or program.2
(7) "Pharmacy benefits plan" or "pharmacy benefits program" means3
a plan or program that pays for, reimburses, covers the cost of, or otherwise4
provides for pharmacist services to individuals who reside in or are employed5
in Louisiana.6
§1864. Requirements for use of the NDC by a pharmacy benefits manager7
A. Before a pharmacy benefits manager places or continues a particular8
NDC or Maximum Allowable Cost List, the following requirements shall be9
met:10
(1) The prescription drug to which the NDC is assigned shall be listed as11
"A" or "B" rated in the most recent version of the FDA's Approved Drug12
Products with Therapeutic Equivalence Evaluations, also known as the Orange13
Book, or have an "NR" or "NA" rating or a similar rating by a nationally14
recognized reference.15
(2) The prescription drug to which the NDC is assigned shall be available16
for purchase by pharmacies in the state from national or regional wholesalers.17
(3) The prescription drug to which the NDC is assigned shall not be18
considered obsolete.19
B. A pharmacy benefits manager shall be required to:20
(1) Provide access to its Maximum Allowable Cost List to each pharmacy21
subject to the list.22
(2) Update its Maximum Allowable Cost List on a timely basis, but in no23
event longer than seven calendar days from a change in the methodology on24
which the Maximum Allowable Cost List is based or in the value of a variable25
involved in the methodology.26
(3) Provide a process for each pharmacy subject to the list to review an27
update to the Maximum Allowable Cost List.28
§1865. Appeals29
A. The pharmacy benefits manager shall provide a reasonable30 SB NO. 410 ENROLLED
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.
administrative appeal procedure to allow pharmacies to challenge maximum1
allowable costs for a specific NDC or NDCs as not meeting the requirements of2
this Subpart or being below the cost at which the pharmacy may obtain the3
NDC. Within seven business days after the applicable fill date, a pharmacy may4
file an appeal by following the appeal process as provided for in this Subpart.5
The pharmacy benefits manager shall respond to a challenge within seven6
business days after receipt of the challenge.7
B. If an appeal made pursuant to this Section is upheld, the pharmacy8
benefits manager shall take the following actions:9
(1) Make the change in the Maximum Allowable Cost List.10
(2) Permit the challenging pharmacy or pharmacist to reverse and rebill11
the claim in question.12
(3) Make the change effective for each similarly situated pharmacy as13
defined by the payor subject to the Maximum Allowable Cost List.14
C. If an appeal made pursuant to this Section is denied, the pharmacy15
benefits manager shall provide the challenging pharmacy or pharmacist the16
NDC number from national or regional wholesalers operating in Louisiana.17
D. A violation of this Subpart shall be deemed an unfair or deceptive act18
and practice pursuant to R.S. 22:1961 et seq.19
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED: