HLS 15RS-1309 ORIGINAL
2015 Regular Session
HOUSE BILL NO. 440
BY REPRESENTATIVE LEBAS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE CLAIMS: Prohibits certain fees relative to the adjudication of pharmacy
benefit claims
1 AN ACT
2To enact R.S. 22:1852(13) and (14) and 1856.2, relative to the adjudication of pharmacy
3 benefit claims; to provide for definitions; to prohibit certain fees relative to such
4 adjudication; and to provide for related matters.
5Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1852(13) and (14) and 1856.2 are hereby enacted to read as
7follows:
8 §1852. Definitions
9 As used in this Subpart, the following terms shall be defined as follows:
10 * * *
11 (13) "Pharmacy benefits manager" means an entity that administers or
12 manages a pharmacy benefits plan or program.
13 (14) "Pharmacy benefits plan" or "pharmacy benefits program" means a plan
14 or program that pays for, reimburses, covers the cost of, or otherwise provides for
15 pharmacist services to individuals who reside in or are employed in Louisiana.
16 * * *
17 §1856.2. Pharmacy benefit claim adjudication
18 Notwithstanding any other provision of this Subpart to the contrary, a health
19 insurance issuer or a pharmacy benefit manager shall not directly or indirectly charge
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 15RS-1309 ORIGINAL
HB NO. 440
1 or hold a pharmacist or pharmacy responsible for a fee for any step of or component
2 or mechanism related to the claim adjudication process, including the following:
3 (1) The adjudication of a pharmacy benefit claim.
4 (2) The processing or transmission of a pharmacy benefit claim.
5 (3) The development or management of a claim processing or adjudication
6 network.
7 (4) Participation in a claim processing or adjudication network.
8 Section 2. This Act shall not apply to any contract entered into or renewed before
9September 15, 2015. However, this Act shall apply to any contract renewed on or after
10September 15, 2015.
11 Section 3. This Act shall become effective on September 1, 2015.
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)]
HB 440 Original 2015 Regular Session LeBas
Abstract: Prohibits certain fees relative to adjudication of pharmacy benefit claims.
Proposed law provides that, notwithstanding any other provision of present law relative to
pharmacy and pharmacist claims, a health insurance issuer or a pharmacy benefit manager
shall not directly or indirectly charge or hold a pharmacist or pharmacy responsible for a fee
for any step of or component or mechanism related to the claim adjudication process,
including the following:
(1)The adjudication of a pharmacy benefit claim.
(2) The processing or transmission of a pharmacy benefit claim.
(3) The development or management of a claim processing or adjudication network.
(4)Participation in a claim processing or adjudication network.
Specifies that proposed law shall not apply to any contract entered into or renewed before
September 1, 2015, but shall apply to any contract renewed on or after September 1, 2015.
Effective on September 1, 2015.
(Adds R.S. 22:1852(13) and (14) and 1856.2)
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions.