SLS 20RS-502 ORIGINAL
2020 Regular Session
SENATE BILL NO. 289
BY SENATOR BARROW
HEALTH/ACC INSURANCE. Provides relative to prohibitions on certain health insurance
cost-sharing practices. (gov sig)
1 AN ACT
2 To amend and reenact R.S. 22:1641(8) and to enact R.S. 22:976.1, relative to prohibitions
3 on certain health insurance cost-sharing practices; to provide for definitions; to
4 provide for fairness in enrollee cost-sharing; and to provide for related matters.
5 Be it enacted by the Legislature of Louisiana:
6 Section 1. R.S. 22:1641(8) is hereby amended and reenacted and R.S. 22:976.1 is
7 enacted to read as follows:
8 §1641. Definitions
9 As used in this Part, unless the context requires otherwise, the following
10 definitions shall be applicable:
11 * * *
12 (8) "Pharmacy benefit manager" means a person, business, or other entity and
13 any wholly or partially owned or controlled subsidiary of such entity that either
14 directly or through an intermediary manages or administers the prescription drug
15 or and device portion of one or more health benefit plans on behalf of a third party,
16 including insurers, plan sponsors, insurance companies, unions, and health
17 maintenance organizations, in accordance with a pharmacy benefit management
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Coding: Words which are struck through are deletions from existing law;
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1 plan. The management or administration of a plan may include but is not
2 limited to review, processing of drug prior authorization requests, adjudication
3 of appeals and grievances related to the prescription drug benefit, contracting
4 with network pharmacies, and controlling the cost of covered prescription
5 drugs.
6 * * *
7 §976.1. Fairness in enrollee cost-sharing
8 A. As used in this Section the following definitions shall be applicable:
9 (1) "Cost-sharing requirement" means any copayment, coinsurance,
10 deductible, or annual limitation on cost-sharing including but not limited to a
11 limitation subject to 42 U.S.C. §18022(c) and 300gg-6(b), required by or on
12 behalf of an enrollee in order to receive a specific healthcare service, including
13 a prescription drug, covered by a health benefit plan.
14 (2) "Enrollee" means an individual who is enrolled or insured by a
15 health insurance issuer for healthcare services.
16 (3) "Health benefit plan" means healthcare services provided directly
17 through insurance, reimbursement, or other means, and including items and
18 services paid for as healthcare services under any hospital or medical service
19 policy or certificate, hospital or medical service plan contract, preferred
20 provider organization contract, or health maintenance organization contract
21 offered by a health insurance issuer.
22 (4) "Healthcare services" means items or services furnished to any
23 individual for the purpose of preventing, alleviating, curing, or healing human
24 illness, injury, mental, or physical disability.
25 (5) "Health insurance issuer" means any entity that offers health
26 insurance coverage through a health benefit plan, policy, or certificate of
27 insurance subject to state law that regulates the business of insurance. "Health
28 insurance issuer" includes a health maintenance organization as defined and
29 licensed pursuant to Subpart I of Part I of Chapter 2 of this Title and the Office
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Coding: Words which are struck through are deletions from existing law;
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1 of Group Benefits as created pursuant to Chapter 12 of Title 42 of the Louisiana
2 Revised Statutes of 1950.
3 (6) "Person" means a natural person, corporation, mutual company,
4 unincorporated association, partnership, joint venture, limited liability
5 company, trust, estate, foundation, not-for-profit corporation, unincorporated
6 organization, government or governmental subdivision, or agency.
7 B. When calculating an enrollee's contribution to any applicable
8 cost-sharing requirement, a health insurance issuer shall include any
9 cost-sharing amounts paid by the enrollee or on behalf of the enrollee by
10 another person.
11 C. In implementing the requirements of this Section, the state shall
12 regulate a health insurance issuer only to the extent permissible under
13 applicable law.
14 D. The commissioner of insurance may promulgate rules and regulations
15 necessary to implement this Section.
16 Section 3. This Act shall become effective upon signature by the governor or, if not
17 signed by the governor, upon expiration of the time for bills to become law without signature
18 by the governor, as provided by Article III, Section 18 of the Constitution of Louisiana. If
19 vetoed by the governor and subsequently approved by the legislature, this Act shall become
20 effective on the day following such approval.
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.
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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. 289
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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)
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Coding: Words which are struck through are deletions from existing law;
words in boldface type and underscored are additions.