HLS 16RS-1206 ENGROSSED
2016 Regular Session
HOUSE BILL NO. 864
BY REPRESENTATIVE LEBAS
INSURANCE CLAIMS: Prohibits certain claims fees assessed by health insurers or
pharmacy benefit managers
1 AN ACT
2To enact R.S. 22:1860.2, relative to pharmacy claims fees; to prohibit health insurance
3 issuers and pharmacy benefit managers from assessing certain such fees; and to
4 provide for related matters.
5Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1860.2 is hereby enacted to read as follows:
7 ยง1860.2. Certain pharmacy claims fees prohibited
8 A. A health insurance issuer or a pharmacy benefit manager may not directly
9 or indirectly charge or hold a pharmacist or pharmacy responsible for any fee related
10 to a claim:
11 (1) That is not apparent at the time of claim processing.
12 (2) That is not reported on the remittance advice of an adjudicated claim.
13 (3) After the initial claim is adjudicated.
14 B. For purposes of this Section, "pharmacy benefit manager" means a
15 person, other than a pharmacy or pharmacist, who acts as an administrator in
16 connection with pharmacy benefits.
Page 1 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 16RS-1206 ENGROSSED
HB NO. 864
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 864 Engrossed 2016 Regular Session LeBas
Abstract: Prohibits health insurance issuers and pharmacy benefit managers from assessing
certain pharmacy claims fees.
Proposed law prohibits a health insurance issuer or a pharmacy benefit manager from
directly or indirectly charging or holding a pharmacist or pharmacy responsible for any fee
related to a claim:
(1)That is not apparent at the time of claim processing.
(2)That is not reported on the remittance advice of an adjudicated claim.
(3)After the initial claim is adjudicated.
Proposed law further defines a "pharmacy benefit manager" as a person, other than a
pharmacy or pharmacist, who acts as an administrator in connection with pharmacy benefits.
(Adds R.S. 22:1860.2)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Require that prohibited fees be related to a claim.
2. Remove fee to participate in a specified provider network from prohibited fees.
Page 2 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.