SLS 18RS-242 ENGROSSED
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 ENGROSSED
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 or credits 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 may be
16 amended to comply with the provisions of this Section. The department may
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 that include the provision of pharmacy or pharmacy benefit manager
25 services shall include the provisions of Subsection A of this Section. The
26 Louisiana Department of Health may issue a requests for proposal for a single
27 state Medicaid pharmacy benefit manager that complies with the provisions of
28 Subsection A of this Section.
29 D. Nothing in this Section shall prevent the Louisiana Department of
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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 ENGROSSED
1 Health from amending pharmacy services out of its current Medicaid managed
2 care organization contracts and providing those services under a single
3 pharmacy benefit manager so long as such action is in compliance with the
4 Louisiana Procurement Code and the contract requirements set forth in
5 Subsection A of this Section.
6 E. No pharmacy benefit manager or Medicaid managed care
7 organization that subcontracts or has a subsidiary pharmacy benefit manager
8 shall deny any Louisiana licensed pharmacy or Louisiana licensed pharmacist
9 the right to be a participating provider in the managed care organization or
10 pharmacy benefit manager's provider network.
11 F. The Louisiana Department of Health shall promulgate rules as may
12 be necessary to comply with the provisions of this Section in accordance with
13 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 Engrossed 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, credits, or "spread pricing" amounts in excess
of what they paid the pharmacist.
Proposed law allows the Louisiana Department of Health (LDH) to amend current contracts
to comply with these provisions. Proposed law allows 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 include the provisions of present law
in any requests for proposal for Medicaid managed care organizations or pharmacy benefit
managers. Proposed law allows LDH to issue a requests for proposal for a single pharmacy
benefit manager. Proposed law allows LDH to amend pharmacy services out of the current
Medicaid managed care organization contracts and issue a requests for proposal to provide
this service as long as it complies with the Louisiana Procurement Code and the contracting
requirements of proposed law.
Proposed law establishes an "any willing provider" clause to prohibit Medicaid managed
care organizations or pharmacy benefit managers from denying Louisiana licensed
pharmacies and pharmacists from the opportunity to participate in the plan provider
networks.
Effective August 1, 2018.
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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 ENGROSSED
(Adds R.S. 39:1648)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Health and Welfare to
the original bill
1. Adds credits owed to the state to the items that a pharmacy benefit manager
may not retain.
2. Makes provisions regarding immediate application of the contract
requirements permissive.
3. Makes requirement for a single state pharmacy benefit manager permissive.
4. Provides an "any willing provider" clause to prohibit Medicaid managed care
organizations or pharmacy benefit managers from denying Louisiana
licensed pharmacies and pharmacists the opportunity to participating in the
plan provider network.
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.