The original instrument and the following digest, which constitutes no part of the
legislative instrument, were prepared by Cheryl B. Cooper.
DIGEST
SB 289 Original 2020 Regular Session Barrow
Present law provides for regulations and definitions for third-party administrators, defining
"pharmacy benefit manager" as a person, business, or other entity and any wholly or partially owned
or controlled subsidiary of such entity that administers a pharmacy benefit management plan.
Proposed law retains present law and specifies that for the definitions of "pharmacy benefit
manager", the management or administration of a benefit plan may include review, processing of
drug prior authorization requests, adjudication of appeals and grievances related to the prescription
drug benefit, contracting with network pharmacies, and controlling the cost of covered prescription
drugs.
Proposed law provides for fairness in enrollee cost-sharing. Defines terms for purposes of proposed
law, including "cost-sharing requirement", "enrollee", "health benefit plan", "healthcare services",
"health insurance issuer", and "person".
Proposed law provides that when calculating an enrollee's contribution to any applicable cost-sharing
requirement, a health insurance issuer shall include any cost sharing amounts paid by the enrollee
or on behalf of the enrollee by another person.
Proposed law provides that in implementing the requirements of proposed law, the state shall
regulate a health insurance issuer only to the extent permissible under applicable law. Allows the
commissioner of insurance to promulgate rules and regulations necessary to implement proposed
law.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1641(8); adds R.S. 22:976.1)