SLS 18RS-242 ORIGINAL
2018 Regular Session
SENATE BILL NO. 130
BY SENATOR MILLS
MEDICAID. Provides relative to contracts for Medicaid pharmacy benefit management
services. (8/1/18)
1 AN ACT
2 To enact Subpart L of Part III of Chapter 17 of Subtitle III of Title 39 of the Louisiana
3 Revised Statutes of 1950, to be comprised of R.S. 39:1648, relative to Medicaid
4 payments for pharmacy benefit manager services; to provide for managed care
5 contracts; to provide for Medicaid managed care subcontracts; and to provide for
6 related matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. Subpart L of Part III of Chapter 17 of Subtitle III of Title 39 of the
9 Louisiana Revised Statutes of 1950, comprised of R.S. 39:1648, is hereby enacted to read
10 as follows:
11 SUBPART L. MEDICAID MANAG ED CARE
12 ยง1648. Medicaid contracts or subcontracts for pharmacy benefit manager
13 services
14 A. Contracts for pharmacy benefit manager services, either directly with
15 the Louisiana Department of Health or as a subcontractor or subsidiary of a
16 managed care organization that has a contract with the Louisiana Department
17 of Health, shall be awarded based only on the following provisions:
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 130
SLS 18RS-242 ORIGINAL
1 (1) Any contract for pharmacy benefit manager services shall be limited
2 to a transaction fee only, based on a set rate established by the Louisiana
3 Department of Health to be paid to the pharmacy benefit manager for each
4 Medicaid pharmacy claim processed.
5 (2) No pharmacy benefit manager may retain any portion of state
6 supplemental rebates submitted to the state by any pharmaceutical
7 manufacturer.
8 (3) No pharmacy benefit manager may retain any portion of "spread
9 pricing". For purposes of this Section, "spread pricing" shall mean any amount
10 charged or claimed by a pharmacy benefit manager to a managed care
11 organization that is in excess of the amount paid to the pharmacy that filled the
12 prescription.
13 B. Any Louisiana Department of Health contract in existence on August
14 1, 2018, with a pharmacy benefit manager or with a managed care organization
15 that subcontracts or has a subsidiary pharmacy benefit manager shall be
16 amended to comply with the provisions of this Section. The department shall
17 terminate the contract with any managed care organization or pharmacy
18 benefit manager who is not willing to amend their contract to comply with the
19 provisions of this Section, and the provision of this service shall be opened for
20 bid to other pharmacy benefit managers in accordance with the Louisiana
21 Procurement Code, R.S. 39:1551 et seq.
22 C. After August 1, 2018, any subsequent requests for proposal issued by
23 the Louisiana Department of Health for Medicaid managed care organization
24 services shall not include the provision of pharmacy or pharmacy benefit
25 manager services. The Louisiana Department of Health shall issue a requests
26 for proposal for a single state Medicaid pharmacy benefit manager that
27 complies with the provisions of Subsection A of this Section.
28 D. Nothing in this Section shall prevent the Louisiana Department of
29 Health from amending pharmacy services out of its current Medicaid managed
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions. SB NO. 130
SLS 18RS-242 ORIGINAL
1 care organization contracts and providing those services under a single
2 pharmacy benefit manager so long as such action is in compliance with the
3 Louisiana Procurement Code and the contract requirements set forth in
4 Subsection A of this Section.
5 E. The Louisiana Department of Health shall promulgate rules as may
6 be necessary to comply with the provisions of this Section in accordance with
7 the Administrative Procedure Act, R.S 49:950 et seq.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 130 Original 2018 Regular Session Mills
Proposed law requires Medicaid pharmacy benefit manager contracts to be limited to a set
per transaction rate for every pharmacy claim paid. Proposed law prohibits pharmacy benefit
managers from retaining federal drug rebates or "spread pricing" amounts in excess of what
they paid the pharmacist.
Proposed law requires the Louisiana Department of Health (LDH) to amend current
contracts to comply with these provisions. Proposed law requires LDH to terminate the
contract of any managed care organization or pharmacy benefit manager who does not wish
to adhere to these contract provisions and issue a request for proposal to other pharmacy
benefit managers.
Proposed law requires LDH, after August 1, 2018, to issue separate requests for proposal for
a single pharmacy benefit manager upon subsequently issuing requests for proposal for
Mediciad managed care organizations. Proposed law allows LDH to issue a requests for
proposal for a single pharmacy benefit manager sooner so long as it complies with the
Louisiana Procurement Code and the contracting requirements of proposed law.
Effective August 1, 2018.
(Adds R.S. 39:1648)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.