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)]
CONFERENCE COMMITTEE REP ORT DIGEST
HB 436 2018 Regular Session Johnson
Keyword and oneliner of the instrument as it left the House
INSURANCE/HEALTH: Provides relative to the regulation of pharmacy benefit managers
Report adopts Senate amendments to:
1. Prohibit an entity that administers prescription drug benefits programs from prohibiting by
contract a pharmacy or pharmacist from informing a patient of all relevant options including
the cost and clinical efficacy of a more affordable alternative if one is available and the
ability to pay cash if a cash price for the same drug is less than an insurance copayment or
deductible payment amount.
2. Require the reimbursement amount requested in a pharmacist's appeal to be granted if the
commissioner of insurance is unable to obtain information from the pharmacy benefit
manager that is necessary to resolve the pharmacist's complaint.
3. Require information designated as proprietary by the pharmacy benefit manager to be given
confidential treatment.
4. Authorize the commissioner to promulgate rules and regulations necessary or proper to carry
out the provisions of proposed law.
5. Permit an entity that administers prescription drug benefits programs to apply for an
administrative hearing pursuant to present law.
6. Delete the Senate committee amendment that narrowed the applicability of proposed law to
pharmacies with fewer than 10 retail outlets physically located within the state under a
common corporate umbrella.
Report rejects Senate amendments which would have:
1. Prohibited a health insurance insurer or pharmacy benefit manager from requiring any
pharmacy or pharmacist to hold a license, accreditation, affiliation, or registration other than that required by federal or state law, rules, or regulations.
2. Made any contract provision requiring any pharmacy or pharmacist to hold a license,
accreditation, affiliation, or registration other than that required by federal or state law, rules,
or regulations severable from the contract and considered null and void and not enforceable
in La.
3. Authorized the attorney general to enforce proposed law against any health insurance issuer
or pharmacy benefit manager who fails to comply with the jurisdiction, regulatory, or
licensing authority of the commissioner which may subject the health insurance issuer or
pharmacy benefit manger to action under the Unfair Trade Practices and Consumer
Protection Law. Digest of the bill as proposed by the Conference Committee
Proposed law prohibits a pharmacy benefit manager, insurer, or other entity that administers
prescription drug benefits programs in La. from prohibiting by contract a pharmacy or pharmacist
from informing a patient of all relevant options when acquiring his prescription medication,
including but not limited to the cost and clinical efficacy of a more affordable alternative if one is
available and the ability to pay cash if a cash price for the same drug is less than an insurance
copayment or deductible payment amount.
Proposed law updates the phrase "pharmacy benefits manager" to "pharmacy benefit manager".
Proposed law requires a pharmacy benefit manager to reimburse a pharmacy or pharmacist in this
state an amount not less than the amount that the pharmacy benefit manager reimburses an affiliate
of the pharmacy benefit manager for providing the same services.
Proposed law requires a pharmacy benefit manager, for every drug for which the pharmacy benefit
manager establishes a maximum allowable cost to determine the drug product reimbursement, to
make available to all pharmacies both of the following:
(1)Information identifying the national drug pricing compendia or sources used to obtain the
drug price data.
(2)The comprehensive list of drugs subject to maximum allowable cost by plan and the actual
maximum allowable cost by plan for each drug.
Present law requires a pharmacy benefit manager to perform certain actions after an appeal relative
to maximum allowable cost is upheld.
Proposed law requires the pharmacy benefit manager, if the appeal is granted, to take the following
actions:
(1)Make the change in the Maximum Allowable Cost List to the initial date of service the
appealed drug was dispensed.
(2)Permit the appealing pharmacy and all other pharmacies in the network that filled
prescriptions for patients covered under the same health benefit plan to reverse and resubmit
claims and receive payment based on the adjusted maximum allowable cost from the initial
date of service the appealed drug was dispensed.
(3)Make the change effective for each similarly situated pharmacy as defined by the payor
subject to the Maximum Allowable Cost List and individually notify all pharmacies in the
pharmacy benefit manager's network.
(4)Make retroactive price adjustments in the next payment cycle. Proposed law authorizes a pharmacist or pharmacy to file a complaint with the commissioner of
insurance following a final decision of the pharmacy benefit manager and provides for the
investigation of the complaint.
Proposed law requires the pharmacy benefit manager to provide the commissioner, upon request,
information that is needed to resolve a pharmacist's complaint regarding the pharmacist's appeal to
the pharmacy benefit manager. Proposed law further requires, if the commissioner is unable to
obtain information from the pharmacy benefit manager that is necessary to resolve the complaint,
the reimbursement amount requested in the pharmacist's appeal to be granted.
Proposed law requires information specifically designated as proprietary by the pharmacy benefit
manager to be given confidential treatment pursuant to present law.
Proposed law authorizes the commissioner to impose a reasonable fee upon pharmacy benefit
managers, in addition to a license fee and annual report fee, in order to cover the costs of
implementation and enforcement of present law and proposed law.
Proposed law permits the commissioner to promulgate rules and regulations, in accordance with the
Administrative Procedure Act, that are necessary or proper to carry out the provisions of proposed
law.
Proposed law allows any pharmacy benefit manager, insurer, or other entity that administers
prescription drug benefits programs that is aggrieved by an act of the commissioner to apply for a
hearing pursuant to present law.
Effective Jan. 1, 2019.
(Amends R.S. 22:1060.6(B), 1863(intro. para.), (1) and (6), 1864(A)(intro. para.) and (3) and
(B)(intro. para.) and 1865; Adds R.S. 22:1060.6(C), 1860.3, 1863(8), 1864(A)(4), and 1866)