The original instrument was prepared by Christine Arbo Peck. The following digest,
which does not constitute a part of the legislative instrument, was prepared by Cathy
R. Wells.
DIGEST
SB 164 Reengrossed 2019 Regular Session Morrish
Present law provides for regulation of prior authorization procedures for prescription drugs.
Proposed law retains present law and makes technical changes.
Present law requires insurers to provide certain override procedures for physicians when step therapy
or fail first protocols are utilized. Proposed law retains present law and adds a process for exemption
from step therapy for patients who have clinical documentation that a prescription drug was
discontinued due to lack of efficacy or effectiveness, diminished effect, or an adverse event.
Proposed law provides that a plan shall not be prevented from requiring a patient to try a generic
drug. Proposed law provides that a practitioner shall not be prevented from prescribing what he
determines to be medically necessary.
Proposed law authorizes additional override of restrictions if:
(1)The prescribing physician can demonstrate to the health coverage plan that the preferred
treatment required under the step therapy or fail first protocol was discontinued due to lack
of efficacy or effectiveness, diminished effect, or an adverse event.
(2)The prescribing physician can demonstrate to the health coverage plan that the criteria set
forth in current law have been satisfied under the insured's current or previous health
coverage plan in the treatment of the insured's disease or medical condition.
Present law requires pharmacy benefit managers to be licensed by the commissioner of insurance
as third party administrators. Proposed law repeals present law and establishes specific pharmacy
benefit manager licensure and regulation authority for the commissioner of insurance. Proposed law
provides for findings and purpose, rulemaking, license authority, and enforcement.
Present law prohibits pharmacy benefit managers from imposing contract provisions on pharmacists
that prevent the pharmacist from informing patients of all relevant options when acquiring
prescription drugs. Proposed law retains present law.
Present law establishes a dedicated location on the Department of Insurance's website for certain
information regarding pharmacy benefit managers. Present law implements the website on January
1, 2020. Proposed law retains present law.
Effective August 1, 2019.
(Amends R.S. 22:1006.1(A) and 1053(D) and R.S. 44:4.1(B)(11) and 44:4.1(B) as amended by Section 2 of Act 371 of the 2018 Regular Session; adds R.S. 22:1053(B)(4) and (5) and (E), and
1260.41-1260.46; repeals R.S. 22:1657 and 1657 as amended by Section 1 of Act 371 of the 2018
Regular Session)
Summary of Amendments Adopted by Senate
Committee Amendments Proposed by Senate Committee on Insurance to the original bill
1. Makes technical changes.
Summary of Amendments Adopted by Senate
Senate Floor Amendments to engrossed bill
1. Adds additional override of restrictions if certain conditions are met.