HLS 20RS-645 ORIGINAL
2020 Regular Session
HOUSE BILL NO. 608
BY REPRESENTATIVE JORDAN
INSURANCE/HEALTH: Provides relative to the regulation of pharmacy benefit managers
1 AN ACT
2To amend and reenact R.S. 40:2868, relative to the regulation of pharmacy benefit
3 managers; to limit the regulatory authority of the Board of Pharmacy; to provide for
4 an effective date; and to provide for related matters.
5Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 40:2868 is hereby amended and reenacted to read as follows:
7 ยง2868. Pharmacy benefit manager; regulation by Board of Pharmacy; requirements
8 for permitting; limitations
9 A. A pharmacy benefit manager may obtain and maintain a permit from the
10 Board of Pharmacy if the pharmacy benefit manager administers, develops,
11 maintains, performs, or provides one or more of the following pharmacy services in
12 this state or that affects one or more beneficiaries of a pharmacy benefit management
13 plan administered by the pharmacy benefit manager:
14 (1) Adjudication of appeals or grievances related to prescription drug
15 coverage.
16 (2) Disease management programs. For purposes of this Subsection,
17 "disease management program" means a program adopted to guide and care for
18 beneficiaries with chronic health problems to improve the quality of health care
19 provided to them and prevent future need for medical resources by using an
20 integrated comprehensive approach.
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HB NO. 608
1 (3) Drug formularies. For purposes of this Subsection, "drug formulary"
2 means a list of prescription medications or pharmaceutical products developed and
3 approved by each health plan that may be dispensed to a beneficiary through
4 participating pharmacies. A drug formulary may also be referred to as a "preferred
5 drug list", "prior authorization list", or "pharmacopeia".
6 (4) Drug regimen reviews. For purposes of this Subsection, "drug regimen
7 review" means third-party review of all medications a beneficiary is currently using,
8 whether prescribed or over-the-counter, and administered by any method.
9 (5) Prescription drug management programs. For purposes of this
10 Subsection, "prescription drug management program" means a program developed
11 and designed to administer the prescription drug benefit as part of a health plan, and
12 as part of such administration a PBM may contract with pharmacies for
13 implementation and dispensing drugs in accordance with the program.
14 (6) Processing of prior authorization requests. For purposes of this
15 Subsection, "processing of prior authorization requests" means making a
16 determination regarding payment coverage based on an advance approval request
17 submitted by a physician or other healthcare provider before a specific procedure,
18 service, device, supply, or medication is delivered to the beneficiary.
19 (7) Quality care dosing services. For purposes of this Subsection, "quality
20 care dosing services" means electronically checking prescription medications before
21 they are filled at the pharmacy to ensure that the quantity and dosage is consistent
22 with the recommendations of the United States Food and Drug Administration and
23 others.
24 (8) Step therapy procedures. For purposes of this Subsection, "step therapy
25 procedure" means protocols and policies that establish a specific sequence in which
26 prescription drugs for a medical condition are approved for coverage by a health plan
27 for a beneficiary which generally requires cheaper drugs to be used before more
28 costly drugs. Step therapy may also be referred to as "fail first" protocol.
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HB NO. 608
1 (9) Utilization management and utilization reviews. For purposes of this
2 Subsection, "utilization management" and "utilization review" mean third-party
3 review and approval of appropriateness and necessity of care that a healthcare
4 provider has indicated for a beneficiary prior to delivery and coverage of such care.
5 (10) Any other act, service, operation, or transaction incidental to or forming
6 a part of the compounding, filling, dispensing, exchanging, giving, offering for sale,
7 or selling drugs, medicines, poisons, or devices in this state by pharmacists or
8 pharmacies, pursuant to a prescription or an order of physicians, dentists,
9 veterinarians, or other licensed practitioners, requiring, involving, or employing the
10 science or art of any branch of the pharmacy profession, study, or training.
11 B. Every pharmacy benefit manager permitted by the Board of Pharmacy
12 shall abide by the applicable provisions of the Louisiana Pharmacy Practice Act and
13 the rules and regulations of the Board of Pharmacy.
14 C. The Board of Pharmacy shall not adopt any permitting requirements that
15 conflict with those established in R.S. 22:1651 for third-party administrators.
16 Section 2. The provisions of Section 1 of this Act supersede the provisions of
17Section 3 of Act 124 of the 219 Regular Session of the Legislature that enacts R.S. 40:2868.
18 Section 3.(A) Section 1 of this Act shall become effective when Section 3 of Act 124
19of the 2019 Regular Session of the Legislature becomes effective.
20 (B) Section 2 and this Section of this Act shall become effective on July 1,
21 2020.
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 608 Original 2020 Regular Session Jordan
Abstract: Prohibits the Board of Pharmacy from adopting any permitting requirements for
pharmacy benefit managers that conflict with those established in the La. Insurance
Code for third-party administrators.
Present law requires pharmacy benefit managers to be licensed by the commissioner of
insurance, registered with the La. secretary of state, and, if they perform certain services
identified in present law, permitted by the La. Board of Pharmacy.
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HB NO. 608
Proposed law limits the regulatory authority of the La. Board of Pharmacy by prohibiting
the board from adopting any permitting requirements that conflict with those established in
the Louisiana Insurance Code for third-party administrators.
Proposed law supersedes the provisions of Act 124 of the 2019 Regular Session of the
Legislature that enact R.S. 40:2868.
Effective July 1, 2020.
(Amends R.S. 40:2868)
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