SLS 19RS-1258 ENGROSSED
2019 Regular Session
SENATE BILL NO. 239(Substitute of Senate Bill No. 48 by Senator Mills)
BY SENATOR MILLS
MEDICAID. Provides relative to the Medicaid prescription drug benefit program. (8/1/19)
1 AN ACT
2 To amend and reenact the introductory paragraph R.S. 46:153.3(B)(2)(a) and to enact R.S.
3 46:450.7, relative to the Medicaid prescription drug benefit program; to provide for
4 the administration of the Medicaid prescription drug benefit program; to provide for
5 reporting; to provide for a single preferred drug list; and to provide for related
6 matters.
7 Be it enacted by the Legislature of Louisiana:
8 Section 1. The introductory paragraph of R.S. 46:153.3(B)(2)(a) is hereby amended
9 and reenacted to read as follows:
10 §153.3. Medical vendor reimbursements; allowable restrictions; peer-based
11 prescribing and dispensing practice patterns; Medicaid
12 Pharmaceutical and Therapeutics Committee
13 * * *
14 B.(1) * * *
15 * * *
16 (2)(a) The department may shall establish a single preferred drug list that
17 utilizes a prior approval process or any other process or combination of processes
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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. 239
SLS 19RS-1258 ENGROSSED
1 that prove to be cost-effective in the medical assistance program. The single
2 preferred drug list shall include all covered therapeutic drug classes that are
3 subject to prior authorization. At a minimum any prior approval process shall meet
4 all of the following criteria:
5 * * *
6 Section 2. R.S. 46:450.7 is hereby enacted to read as follows:
7 §450.7. Medicaid prescription drug benefit program
8 A. The Louisiana Department of Health shall administer the Medicaid
9 prescription drug benefit program in accordance with the authority provided
10 for in this Section.
11 (1) The department is authorized to remove pharmacy services from
12 Medicaid managed care organization contracts and assume direct responsibility
13 for all Louisiana Medicaid pharmacy services. To comply with this Paragraph,
14 the department may utilize national best practices and techniques to assist with
15 member medication adherence and to control costs, including but not limited
16 to implementation of a preferred drug list in accordance with R.S. 46:153.3,
17 utilization of medication therapy management in accordance with R.S.
18 46:153.3.1, and other clinically effective cost efficient options allowed by state
19 and federal law.
20 (2) If the department does not exercise the authority provided for in
21 Paragraph (1) of this Subsection and administers the Medicaid pharmacy
22 program through use of one or more Medicaid managed care organization
23 pharmacy benefit managers, the pharmacy benefit manager shall be
24 reimbursed a transaction fee only and shall not retain any portion of "spread
25 pricing" or state supplemental rebates, as set forth in R.S. 39:1648. In addition,
26 a Medicaid managed care organization or a Medicaid managed care
27 organization pharmacy benefit manager shall not:
28 (a) Buy, sell, transfer, or provide Medicaid recipient personal healthcare
29 or contact information to any other party, including subsidiaries of the
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1 pharmacy benefit manager, for any purpose unless specifically authorized to do
2 so by the department, and under no circumstance may such activity be for the
3 purpose of patient steering. For purposes of this Section, "patient steering"
4 means encourage or entice any Medicaid recipient to switch to any pharmacy,
5 including a mail-order pharmacy, through unsolicited advice or
6 mass-marketing directed at a Medicaid recipient by a pharmacy benefit
7 manager, including any employees, affiliated providers, agents, or contractors,
8 that is intended to influence or that can reasonably be concluded to influence
9 the Medicaid recipient to change pharmacies.
10 (b) Deny any Louisiana licensed pharmacy or Louisiana licensed
11 pharmacist the right to be a participating provider in the managed care
12 organization pharmacy benefit manager's provider network if the pharmacy or
13 pharmacist meets all requirements of participation in the state Medicaid
14 program.
15 (c) Deduct healthcare provider fees due to the state pursuant to R.S.
16 46:2625 from any amount due as reimbursement to a pharmacist or pharmacy.
17 (d) Deduct sales taxes owed to any taxing authority imposing the sales
18 tax pursuant to R.S. 47:337.11.1 from any amount due as reimbursement to a
19 pharmacist or pharmacy.
20 B. The department has a duty to administer the Medicaid prescription
21 drug benefit program in the most clinically effective and cost efficient manner
22 possible. To ensure compliance with this duty, the department shall develop a
23 comprehensive plan to administer the Medicaid prescription drug program and
24 submit the plan to the Senate Committee on Health and Welfare, Senate
25 Finance Committee, House Committee on Health and Welfare, and House
26 Appropriations Committee on February 1, 2020. At a minimum, the
27 comprehensive plan shall include the following:
28 (1) Best practices and clinical and cost outcomes from other states that
29 have removed pharmacy services from Medicaid managed care organization
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Coding: Words which are struck through are deletions from existing law;
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1 contracts and assume direct administrative responsibility.
2 (2) Managed care organization portal access to ensure coordination of
3 patient care if pharmacy services are removed from Medicaid managed care
4 organization contracts.
5 (3) Maximum rebate utilization through participation in the most
6 effective bulk purchasing multi-state buying pool.
7 C. Notwithstanding any provision of law to the contrary, no Medicaid
8 managed care organization shall use a pharmacy benefit manager for Medicaid
9 if the pharmacy benefit manager is part of a larger company that also owns
10 retail pharmacies.
The original instrument and the following digest, which constitutes no part
of the legislative instrument, were prepared by Christine Arbo Peck.
DIGEST
SB 239 Engrossed 2019 Regular Session Mills
Present law authorizes the La. Department of Health to implement a prior approval process
for Medicaid prescription drugs. Proposed law retains present law and mandates a single
preferred drug list that shall include all therapeutic drug classes that are subject to prior
authorization.
Proposed law authorizes the La. Department of Health to remove pharmacy services from
Medicaid managed care organization contracts and assume direct responsibility for all
Louisiana Medicaid pharmacy services. Proposed law provides that if the department
administers the Medicaid pharmacy program through use of one or more Medicaid managed
care organization pharmacy benefit managers certain provisions in proposed law must be
adhered to.
Proposed law provides that the department has a duty to administer the Medicaid
prescription drug benefit program in the most clinically effective cost efficient manner
possible. Proposed law requires the department to develop and submit a comprehensive plan
to administer the Medicaid prescription drug program and submit the plan to the Senate and
House committees on health and welfare, Senate Finance Committee, and House
Appropriations Committee on February 1, 2020.
Proposed law prohibits a Medicaid managed care organization from using a pharmacy
benefit manager for Medicaid if the pharmacy benefit manager is part of a larger company
that also owns retail pharmacies.
Effective August 1, 2019.
(Amends R.S. 46:153.3(B)(2)(a)(intro para); adds R.S. 46:450.7)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.