2018 Regular Session ENROLLED
SENATE BILL NO. 130
BY SENATOR MILLS
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:
18 (1) Any contract for pharmacy benefit manager services shall be limited
19 to a transaction fee only, based on a set rate established by the Louisiana
20 Department of Health to be paid to the pharmacy benefit manager for each
21 Medicaid pharmacy claim processed.
22 (2) No pharmacy benefit manager may retain any portion of state
23 supplemental rebates or credits submitted to the state by any pharmaceutical
24 manufacturer.
25 (3) No pharmacy benefit manager may retain any portion of "spread
26 pricing". For purposes of this Section, "spread pricing" shall mean any amount
27 charged or claimed by a pharmacy benefit manager to a managed care
28 organization that is in excess of the amount paid to the pharmacy that filled the
ACT No. 483
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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 ENROLLED
1 prescription.
2 B. Any Louisiana Department of Health contract in existence on August
3 1, 2018, with a pharmacy benefit manager or with a managed care organization
4 that subcontracts or has a subsidiary pharmacy benefit manager may be
5 amended to comply with the provisions of this Section. The department may
6 terminate the contract with any managed care organization or pharmacy
7 benefit manager who is not willing to amend their contract to comply with the
8 provisions of this Section, and the provision of this service shall be opened for
9 bid to other pharmacy benefit managers in accordance with the Louisiana
10 Procurement Code, R.S. 39:1551 et seq.
11 C. After August 1, 2018, any subsequent requests for proposal issued by
12 the Louisiana Department of Health for Medicaid managed care organization
13 services that include the provision of pharmacy or pharmacy benefit manager
14 services shall include the provisions of Subsection A of this Section.
15 D. No pharmacy benefit manager or Medicaid managed care
16 organization that subcontracts or has a subsidiary pharmacy benefit manager
17 shall deny any Louisiana licensed pharmacy or Louisiana licensed pharmacist
18 the right to be a participating provider in the managed care organization or
19 pharmacy benefit manager's provider network if the pharmacy or pharmacist
20 meets all requirements of participation in the state Medicaid program.
21 E. The Louisiana Department of Health shall promulgate rules as may
22 be necessary to comply with the provisions of this Section in accordance with
23 the Administrative Procedure Act, R.S. 49:950 et seq.
PRESIDENT OF THE SENATE
SPEAKER OF THE HOUSE OF REPRESENTATIVES
GOVERNOR OF THE STATE OF LOUISIANA
APPROVED:
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.