HLS 19RS-812 ORIGINAL
2019 Regular Session
HOUSE BILL NO. 242
BY REPRESENTATIVE LEBAS
Prefiled pursuant to Article III, Section 2(A)(4)(b)(i) of the Constitution of Louisiana.
INSURANCE CLAIMS: Prohibits certain claims fees assessed by health insurers or
pharmacy benefit managers
1 AN ACT
2To amend and reenact R.S. 22:1860.2(A), relative to pharmacy claims fees; to prohibit
3 health insurance issuers and pharmacy benefit managers from assessing certain
4 pharmacy claims fees; to provide for an effective date; and to provide for related
5 matters.
6Be it enacted by the Legislature of Louisiana:
7 Section 1. R.S. 22:1860.2(A) is hereby amended and reenacted to read as follows:
8 ยง1860.2. Certain pharmacy claims fees prohibited
9 A. A health insurance issuer or a pharmacy benefit manager may shall not
10 directly or indirectly charge or hold a pharmacist or pharmacy responsible for any
11 fee related to a claim that is any of the following:
12 (1) That is not Not apparent at the time of claim processing.
13 (2) That is not Not reported on the remittance advice of an adjudicated claim.
14 (3) After the initial claim is adjudicated.
15 * * *
16 Section 2. This Act shall become effective upon signature by the governor or, if not
17signed by the governor, upon expiration of the time for bills to become law without signature
18by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
19vetoed by the governor and subsequently approved by the legislature, this Act shall become
20effective on the day following such approval.
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CODING: Words in struck through type are deletions from existing law; words underscored
are additions. HLS 19RS-812 ORIGINAL
HB NO. 242
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 242 Original 2019 Regular Session LeBas
Abstract: Prohibits health insurance issuers and pharmacy benefit managers from assessing
certain pharmacy claims fees.
Present law provides that a health insurance issuer or a pharmacy benefit manager may not
directly or indirectly charge or hold 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 retains present law but clarifies that health insurance issuers and pharmacy
benefit managers are prohibited from assessing any fee that meets any of the enumerated
criteria.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1860.2(A))
Page 2 of 2
CODING: Words in struck through type are deletions from existing law; words underscored
are additions.