RÉSUMÉ DIGEST
ACT 263 (SB 239) 2019 Regular Session Mills
Prior law authorizes the La. Department of Health to implement a prior approval process for
Medicaid prescription drugs. New law retains prior law and mandates a single preferred drug
list that shall include all therapeutic drug classes that are subject to prior authorization.
New 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. New 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 new law must be adhered to.
New 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. New 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.
New law requires that the following information, at a minimum, be included in the La.
Department of Health's comprehensive plan:
(1)Best practices, clinical, and cost outcomes from other states that have removed
pharmacy services from Medicaid managed care organizations contracts and assume
direct administrative responsibility.
(2)Managed care organization portal access to ensure coordination of patient care if
pharmacy services are removed from Medicaid managed care organization contracts.
(3)Maximum rebate utilization through participation in the most effective bulk
purchasing multi-state buying pool.
(4)Medicaid managed care organization use of a pharmacy benefit manager for
Medicaid prescription drug benefit program administration 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)